Provider Demographics
NPI:1376875310
Name:NORTH EAST LASER VEIN INSTITUTE LLC
Entity Type:Organization
Organization Name:NORTH EAST LASER VEIN INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NAWEED
Authorized Official - Middle Name:K
Authorized Official - Last Name:MAJID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-445-4410
Mailing Address - Street 1:257 E RIDGEWOOD AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3886
Mailing Address - Country:US
Mailing Address - Phone:201-445-4410
Mailing Address - Fax:201-444-7594
Practice Address - Street 1:257 E RIDGEWOOD AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3886
Practice Address - Country:US
Practice Address - Phone:201-445-4410
Practice Address - Fax:201-444-7594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-01
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA033019002086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ220493Medicare PIN