1255084786 NPI number — WEST ORANGE ENDOVASCULAR CENTER 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 1255084786 NPI number — WEST ORANGE ENDOVASCULAR CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST ORANGE ENDOVASCULAR CENTER 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:
1255084786
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
182 INDUSTRIAL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLEN ROCK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17327-8626
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
833-426-3636
Provider Business Mailing Address Fax Number:
717-759-5435

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
347 MOUNT PLEASANT AVE STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST ORANGE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07052-2745
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-719-6586
Provider Business Practice Location Address Fax Number:
973-947-6647
Provider Enumeration Date:
02/03/2022

Additional Information

Authorized Official

Authorized Official Last Name:
FIGUEROA
Authorized Official First Name:
RAYMOND
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
833-426-3636

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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