Provider Demographics
NPI:1881181733
Name:VEIN CARE ASSOCIATES OF NJ INC.
Entity Type:Organization
Organization Name:VEIN CARE ASSOCIATES OF NJ INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GRIGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHTENDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-791-7771
Mailing Address - Street 1:31-00 BROADWAY SUITE 1
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410
Mailing Address - Country:US
Mailing Address - Phone:201-791-7771
Mailing Address - Fax:201-791-7337
Practice Address - Street 1:576 VALLEY BROOK AVE.
Practice Address - Street 2:SUITE 2
Practice Address - City:LYNDHURST
Practice Address - State:NJ
Practice Address - Zip Code:07071
Practice Address - Country:US
Practice Address - Phone:201-791-7771
Practice Address - Fax:201-791-7337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07870200174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty