Provider Demographics
NPI:1851770291
Name:VEIN CENTRE FERNANDO SEGOVIA, MD
Entity Type:Organization
Organization Name:VEIN CENTRE FERNANDO SEGOVIA, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LOPRESTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-941-8100
Mailing Address - Street 1:38 MEADOWLANDS PKWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-2925
Mailing Address - Country:US
Mailing Address - Phone:201-941-8100
Mailing Address - Fax:201-941-1235
Practice Address - Street 1:38 MEADOWLANDS PKWY
Practice Address - Street 2:SUITE 1
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-2925
Practice Address - Country:US
Practice Address - Phone:201-941-8100
Practice Address - Fax:201-941-1235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-19
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05963600207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty