| Organization Name: | NJ VEIN & COSMETIC SURGERY CENTER, PA |
| NPI Number: | 1063531911 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JANEL DIMARIA (DIRECTOR OF OPERATIONS) |
| Mailing Address: | 741 Northfield Ave Suite 105 West Orange |
| State: | NJ US |
| Postal Code: | 070521174 |
| Phone Number: | 9732432200 |
| Fax Number: | 9732431409 |
| NPI Enumeration Date: | 03/29/2007 |
| NPI Last Update Date: | 06/22/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA1903X |
| License Number: | 311087 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Surgical |
| Taxonomy Definition: | |