Provider Demographics
NPI:1437866878
Name:NJ VEIN SPECIALISTS
Entity Type:Organization
Organization Name:NJ VEIN SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:JENNACO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-371-3932
Mailing Address - Street 1:PO BOX 500
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-0500
Mailing Address - Country:US
Mailing Address - Phone:201-371-3932
Mailing Address - Fax:201-514-1434
Practice Address - Street 1:208 HARRISTOWN RD # LEVEL1
Practice Address - Street 2:
Practice Address - City:GLEN ROCK
Practice Address - State:NJ
Practice Address - Zip Code:07452-3308
Practice Address - Country:US
Practice Address - Phone:201-371-3932
Practice Address - Fax:201-514-1434
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROGRESSIVE SPINE & ORTHOPAEDICS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty