Provider Demographics
NPI:1740234301
Name:VASCULAR ACCESS CENTER OF TRENTON LLC
Entity Type:Organization
Organization Name:VASCULAR ACCESS CENTER OF TRENTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:PARKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-382-3680
Mailing Address - Street 1:1450 PARKSIDE AVE
Mailing Address - Street 2:UNIT 18
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08638-2946
Mailing Address - Country:US
Mailing Address - Phone:609-882-1770
Mailing Address - Fax:609-882-8406
Practice Address - Street 1:1450 PARKSIDE AVE
Practice Address - Street 2:UNIT 18
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08638-2946
Practice Address - Country:US
Practice Address - Phone:609-882-1770
Practice Address - Fax:609-882-8406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJDF7654OtherRAILROAD MEDICARE
NJ0105953Medicaid
NJDF7654OtherRAILROAD MEDICARE