Provider Demographics
NPI:1134937097
Name:VASCULAR AND INTERVENTIONAL SPECIALISTS, PC
Entity type:Organization
Organization Name:VASCULAR AND INTERVENTIONAL SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:B
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-930-0088
Mailing Address - Street 1:26 DRIFTWOOD LN
Mailing Address - Street 2:
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-2120
Mailing Address - Country:US
Mailing Address - Phone:201-725-7137
Mailing Address - Fax:
Practice Address - Street 1:300 PERRINE RD STE 302
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-3629
Practice Address - Country:US
Practice Address - Phone:201-725-7137
Practice Address - Fax:732-727-8345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-24
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty