Provider Demographics
NPI:1508041864
Name:GENERAL VASCULAR SURGICAL ASSOCIATES OF SOUTH JERSEY, P.A.
Entity Type:Organization
Organization Name:GENERAL VASCULAR SURGICAL ASSOCIATES OF SOUTH JERSEY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:S
Authorized Official - Last Name:PILLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-848-8242
Mailing Address - Street 1:17 W RED BANK AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-1630
Mailing Address - Country:US
Mailing Address - Phone:856-848-8242
Mailing Address - Fax:
Practice Address - Street 1:17 W RED BANK AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-1630
Practice Address - Country:US
Practice Address - Phone:856-848-8242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty