Provider Demographics
NPI:1033142328
Name:ADVANCED VASCULAR SOLUTIONS, P.A.
Entity Type:Organization
Organization Name:ADVANCED VASCULAR SOLUTIONS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOUIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-345-8346
Mailing Address - Street 1:766 SHREWSBURY AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-3001
Mailing Address - Country:US
Mailing Address - Phone:732-345-8346
Mailing Address - Fax:732-345-8351
Practice Address - Street 1:766 SHREWSBURY AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07724-3001
Practice Address - Country:US
Practice Address - Phone:732-345-8346
Practice Address - Fax:732-345-8351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ135741Medicare PIN