Provider Demographics
NPI:1821323700
Name:NJVEINCARE, LLC
Entity Type:Organization
Organization Name:NJVEINCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:B
Authorized Official - Last Name:NACKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-778-2222
Mailing Address - Street 1:1037 US HIGHWAY 46
Mailing Address - Street 2:STE 202
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-2459
Mailing Address - Country:US
Mailing Address - Phone:973-778-2222
Mailing Address - Fax:
Practice Address - Street 1:1037 US HIGHWAY 46 STE 202
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-2459
Practice Address - Country:US
Practice Address - Phone:739-778-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-09
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA064837002086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG38061Medicare UPIN
NJ894196Medicare PIN