Provider Demographics
NPI:1427417344
Name:WEST ORANGE VASCULAR CENTER LLC
Entity Type:Organization
Organization Name:WEST ORANGE VASCULAR CENTER LLC
Other - Org Name:WEST ORANGE VASCULAR CENTER LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:BANJI
Authorized Official - Middle Name:
Authorized Official - Last Name:AWOSIKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-927-5873
Mailing Address - Street 1:1210 E PLANT ST
Mailing Address - Street 2:STE 140
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-2996
Mailing Address - Country:US
Mailing Address - Phone:407-297-8408
Mailing Address - Fax:407-297-8409
Practice Address - Street 1:1210 E PLANT ST
Practice Address - Street 2:STE 140
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-2996
Practice Address - Country:US
Practice Address - Phone:407-297-8408
Practice Address - Fax:407-297-8409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-19
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty