Provider Demographics
NPI:1922080555
Name:VASCULAR LABORATORY OF WESTERN NEW ENGLAND
Entity Type:Organization
Organization Name:VASCULAR LABORATORY OF WESTERN NEW ENGLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:KAUFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-784-0900
Mailing Address - Street 1:3500 MAIN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1110
Mailing Address - Country:US
Mailing Address - Phone:413-784-0900
Mailing Address - Fax:413-781-5035
Practice Address - Street 1:3500 MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1110
Practice Address - Country:US
Practice Address - Phone:413-784-0900
Practice Address - Fax:413-781-5035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9784187Medicaid
M20565Medicare ID - Type Unspecified