Provider Demographics
NPI:1972754521
Name:VEIN INSTITUTE OF PITTSBURGH, LLC
Entity Type:Organization
Organization Name:VEIN INSTITUTE OF PITTSBURGH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:KRYSINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-934-8346
Mailing Address - Street 1:16000 PERRY HWY
Mailing Address - Street 2:SUITE TWO
Mailing Address - City:WARRENDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15086-7541
Mailing Address - Country:US
Mailing Address - Phone:724-935-4200
Mailing Address - Fax:724-935-4226
Practice Address - Street 1:16000 PERRY HWY
Practice Address - Street 2:SUITE TWO
Practice Address - City:WARRENDALE
Practice Address - State:PA
Practice Address - Zip Code:15086-7541
Practice Address - Country:US
Practice Address - Phone:724-935-4200
Practice Address - Fax:724-935-4226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-01
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-068030-L208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH15586Medicare UPIN