Provider Demographics
NPI:1982035242
Name:NEXGEN ARTERY & VEIN INSTITUTE, LLC
Entity Type:Organization
Organization Name:NEXGEN ARTERY & VEIN INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-376-2967
Mailing Address - Street 1:28089 VANDERBILT DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-7521
Mailing Address - Country:US
Mailing Address - Phone:914-376-2967
Mailing Address - Fax:239-405-8544
Practice Address - Street 1:28089 VANDERBILT DR
Practice Address - Street 2:SUITE 201
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-7521
Practice Address - Country:US
Practice Address - Phone:914-376-2967
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-11
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty