Provider Demographics
NPI:1689808974
Name:VASCULAR AND ENDOVASCULAR ASSOCIATES OF NJ LLC
Entity Type:Organization
Organization Name:VASCULAR AND ENDOVASCULAR ASSOCIATES OF NJ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL SURGEON/VASCULAR SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:TAREK
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALSHAFIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-389-3700
Mailing Address - Street 1:89 N MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3235
Mailing Address - Country:US
Mailing Address - Phone:201-389-3700
Mailing Address - Fax:201-670-6725
Practice Address - Street 1:89 N MAPLE AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3235
Practice Address - Country:US
Practice Address - Phone:201-389-3700
Practice Address - Fax:201-670-6725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-14
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA068808002086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG95401Medicare UPIN