Provider Demographics
NPI:1437859832
Name:NEW JERSEY HEART AND VEIN LLC
Entity Type:Organization
Organization Name:NEW JERSEY HEART AND VEIN LLC
Other - Org Name:NEW JERSEY HEART AND VEIN
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAIBES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:973-327-5000
Mailing Address - Street 1:855 VALLEY RD STE 112B
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-2441
Mailing Address - Country:US
Mailing Address - Phone:973-327-5000
Mailing Address - Fax:973-327-5555
Practice Address - Street 1:855 VALLEY RD STE 112B
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-2441
Practice Address - Country:US
Practice Address - Phone:973-327-5000
Practice Address - Fax:973-327-5555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-06
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MB10927700OtherSTATE LICENSE