1124904651 NPI number — CENTER FOR VEIN RESTORATION CT LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124904651 NPI number — CENTER FOR VEIN RESTORATION CT LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR VEIN RESTORATION CT LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124904651
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7474 GREENWAY CENTER DR STE 1000
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENBELT
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20770-3500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-830-8346
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1290 SUMMER ST STE 2100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STAMFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06905-5340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-830-8346
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/12/2025

Additional Information

Authorized Official

Authorized Official Last Name:
THOMAS
Authorized Official First Name:
LORENA
Authorized Official Middle Name:
Authorized Official Title or Position:
CRED MANAGER
Authorized Official Telephone Number:
815-254-1761

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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