Provider Demographics
NPI:1518037068
Name:GENERAL AND VASCULAR SURGICAL ASSOCIATES OF NORTH JERSEY, P.A.
Entity Type:Organization
Organization Name:GENERAL AND VASCULAR SURGICAL ASSOCIATES OF NORTH JERSEY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:BARATTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-778-6676
Mailing Address - Street 1:905 ALLWOOD RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-1933
Mailing Address - Country:US
Mailing Address - Phone:973-778-6676
Mailing Address - Fax:973-778-2666
Practice Address - Street 1:905 ALLWOOD RD
Practice Address - Street 2:SUITE 204
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-1933
Practice Address - Country:US
Practice Address - Phone:973-778-6676
Practice Address - Fax:973-778-2666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01639394Medicaid
NJ6423108Medicaid
NY01639394Medicaid
010064Medicare PIN