1205865086 NPI number — BOSTON VASCULAR CENTER, L.L.C.

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 1205865086 NPI number — BOSTON VASCULAR CENTER, L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOSTON VASCULAR CENTER, L.L.C.
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:
1205865086
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
225 STATE ROUTE 35
Provider Second Line Business Mailing Address:
SUITE 208
Provider Business Mailing Address City Name:
RED BANK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07701-5919
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-383-4160
Provider Business Mailing Address Fax Number:
732-383-4161

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
340 WOOD RD
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
BRAINTREE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02184-2401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-996-8026
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SVIGALS
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
J
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
856-482-2800

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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