Organization Name: | BROADWAY VASCULAR PC |
NPI Number: | 1235539081 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DALLAS BROADWAY (PRESIDENT) |
Mailing Address: | 205 Bridge St Bldg D Metuchen |
State: | NJ US |
Postal Code: | 088402290 |
Phone Number: | 7322350147 |
Fax Number: | |
NPI Enumeration Date: | 08/29/2014 |
NPI Last Update Date: | 08/29/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR0200X |
License Number: | 25MA09187400 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Radiology |
Taxonomy Definition: |