Provider Demographics
NPI:1023486925
Name:ASSOCIATES IN VASCULAR CARE LLC LIMB SALVAGE CENTER
Entity type:Organization
Organization Name:ASSOCIATES IN VASCULAR CARE LLC LIMB SALVAGE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OWANO
Authorized Official - Middle Name:
Authorized Official - Last Name:PENNYCOOKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-784-6550
Mailing Address - Street 1:3587 HIGHWAY 9 NORTH
Mailing Address - Street 2:SUITE 224
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728
Mailing Address - Country:US
Mailing Address - Phone:732-784-6550
Mailing Address - Fax:
Practice Address - Street 1:1000 ROUTE 35 SOUTH
Practice Address - Street 2:SUITE 300
Practice Address - City:MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748-2606
Practice Address - Country:US
Practice Address - Phone:732-784-6550
Practice Address - Fax:732-737-9836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA085470002086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty