Provider Demographics
NPI:1598537623
Name:HERITAGE VASCULAR SERVICES PC
Entity Type:Organization
Organization Name:HERITAGE VASCULAR SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEKSANDR
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIROSOV
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:973-557-3351
Mailing Address - Street 1:663 E CRESCENT AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-1220
Mailing Address - Country:US
Mailing Address - Phone:973-557-3351
Mailing Address - Fax:201-350-8614
Practice Address - Street 1:421 BROADWAY
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3627
Practice Address - Country:US
Practice Address - Phone:973-557-3351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty