Provider Demographics
NPI:1609289065
Name:NORTH JERSEY VASCULAR CENTER, LLC
Entity Type:Organization
Organization Name:NORTH JERSEY VASCULAR CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOQUETE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-653-3366
Mailing Address - Street 1:246 HAMBURG TPKE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2156
Mailing Address - Country:US
Mailing Address - Phone:973-653-3366
Mailing Address - Fax:973-942-3295
Practice Address - Street 1:246 HAMBURG TPKE
Practice Address - Street 2:SUITE 207
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2156
Practice Address - Country:US
Practice Address - Phone:973-653-3366
Practice Address - Fax:973-942-3295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical