Provider Demographics
NPI:1376721829
Name:VEIN INSTITUTE OF NEW JERSEY
Entity Type:Organization
Organization Name:VEIN INSTITUTE OF NEW JERSEY
Other - Org Name:VEIN AND LASER INSTITUTE OF NJ
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHA4EL
Authorized Official - Middle Name:
Authorized Official - Last Name:OMBRELLINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-539-6900
Mailing Address - Street 1:95 MADISON AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-6092
Mailing Address - Country:US
Mailing Address - Phone:973-539-6900
Mailing Address - Fax:
Practice Address - Street 1:95 MADISON AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6092
Practice Address - Country:US
Practice Address - Phone:973-539-6900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty