Provider Demographics
NPI:1487209870
Name:VASCULAR & VEIN CENTER OF NJ LLC
Entity Type:Organization
Organization Name:VASCULAR & VEIN CENTER OF NJ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:NASIR KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:848-257-1900
Mailing Address - Street 1:10 INDUSTRIAL WAY E STE 103
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-3332
Mailing Address - Country:US
Mailing Address - Phone:848-257-1900
Mailing Address - Fax:
Practice Address - Street 1:10 INDUSTRIAL WAY E STE 103
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-3332
Practice Address - Country:US
Practice Address - Phone:848-257-1900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-03
Last Update Date:2019-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty