Provider Demographics
NPI:1033740774
Name:MONMOUTH VASCULAR IMAGING LLC
Entity Type:Organization
Organization Name:MONMOUTH VASCULAR IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:LEV
Authorized Official - Middle Name:
Authorized Official - Last Name:PUKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-201-2225
Mailing Address - Street 1:4 MOUNTAIN LN
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1107
Mailing Address - Country:US
Mailing Address - Phone:732-201-2225
Mailing Address - Fax:888-960-2493
Practice Address - Street 1:1198 LAKEWOOD RD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-2237
Practice Address - Country:US
Practice Address - Phone:732-201-2225
Practice Address - Fax:888-960-2493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-31
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty