Provider Demographics
NPI:1851722730
Name:SUITE402ASSOCIATES, LLC
Entity Type:Organization
Organization Name:SUITE402ASSOCIATES, LLC
Other - Org Name:PENINSULA VEIN AND LASER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GINALIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-229-8486
Mailing Address - Street 1:279 3RD AVE
Mailing Address - Street 2:SUITE 402
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-6211
Mailing Address - Country:US
Mailing Address - Phone:732-229-8486
Mailing Address - Fax:732-229-1576
Practice Address - Street 1:279 3RD AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-6211
Practice Address - Country:US
Practice Address - Phone:732-229-8486
Practice Address - Fax:732-229-1576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty