Provider Demographics
NPI:1609418839
Name:VEIN RESTORATION MEDICAL GROUP. PC
Entity Type:Organization
Organization Name:VEIN RESTORATION MEDICAL GROUP. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALEKSANDR
Authorized Official - Middle Name:
Authorized Official - Last Name:MARIRSOV
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:201-791-7771
Mailing Address - Street 1:31-00 BROADWAY
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410
Mailing Address - Country:US
Mailing Address - Phone:201-791-7771
Mailing Address - Fax:201-791-7337
Practice Address - Street 1:663 E CRESCENT AVE
Practice Address - Street 2:STE 111
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446
Practice Address - Country:US
Practice Address - Phone:201-791-7771
Practice Address - Fax:201-791-7337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty