Provider Demographics
NPI:1952613242
Name:VENOLASE VASCULAR MEDICINE PLLC
Entity Type:Organization
Organization Name:VENOLASE VASCULAR MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KONLIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-358-8878
Mailing Address - Street 1:2 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-1965
Mailing Address - Country:US
Mailing Address - Phone:845-358-8878
Mailing Address - Fax:
Practice Address - Street 1:2 MEDICAL PARK DR
Practice Address - Street 2:SUITE 4
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-1965
Practice Address - Country:US
Practice Address - Phone:845-358-8878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-02
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1858321207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty