Provider Demographics
NPI:1750443248
Name:THE ENDOVASCULAR INSTITUTE OF NJ LLC
Entity Type:Organization
Organization Name:THE ENDOVASCULAR INSTITUTE OF NJ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:SHINDELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-698-0606
Mailing Address - Street 1:465 CRANBURY ROAD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-7600
Mailing Address - Country:US
Mailing Address - Phone:732-698-0606
Mailing Address - Fax:732-698-0006
Practice Address - Street 1:465 CRANBURY RD
Practice Address - Street 2:SUITE 204
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-7600
Practice Address - Country:US
Practice Address - Phone:732-698-0606
Practice Address - Fax:732-698-0006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04238300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ070314Medicare ID - Type UnspecifiedPRACTICE ID MEDICARE
NJC59896Medicare UPIN