Provider Demographics
NPI:1174630545
Name:VEIN SPECIALISTS OF THE NORTH SHORE LLC
Entity type:Organization
Organization Name:VEIN SPECIALISTS OF THE NORTH SHORE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:I
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-922-8346
Mailing Address - Street 1:100 CUMMINGS CENTER
Mailing Address - Street 2:SUITE 110E
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915
Mailing Address - Country:US
Mailing Address - Phone:978-922-8346
Mailing Address - Fax:978-922-8345
Practice Address - Street 1:100 CUMMINGS CENTER
Practice Address - Street 2:SUITE 110E
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915
Practice Address - Country:US
Practice Address - Phone:978-922-8346
Practice Address - Fax:978-922-8345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9738631Medicaid
MA110069857AMedicaid
MA110069857AMedicaid
MAM21560Medicare ID - Type Unspecified