Provider Demographics
NPI:1841725801
Name:THE ORIGINAL VEIN DOCTOR
Entity type:Organization
Organization Name:THE ORIGINAL VEIN DOCTOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SANFORD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-341-5777
Mailing Address - Street 1:44300 MONTEREY AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-3377
Mailing Address - Country:US
Mailing Address - Phone:760-341-5777
Mailing Address - Fax:760-340-4184
Practice Address - Street 1:44300 MONTEREY AVE
Practice Address - Street 2:SUITE B
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-3377
Practice Address - Country:US
Practice Address - Phone:760-341-5777
Practice Address - Fax:760-340-4184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Single Specialty