Basic Information
| Provider Information | |||||||||
| NPI: | 1033142328 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCED VASCULAR SOLUTIONS, P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 766 SHREWSBURY AVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | TINTON FALLS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077243001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7323458346 | ||||||||
| FaxNumber: | 7323458351 | ||||||||
| Practice Location | |||||||||
| Address1: | 766 SHREWSBURY AVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | TINTON FALLS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077243001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7323458346 | ||||||||
| FaxNumber: | 7323458351 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2006 | ||||||||
| LastUpdateDate: | 04/21/2009 | ||||||||
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| AuthorizedOfficialLastName: | LOUIE | ||||||||
| AuthorizedOfficialFirstName: | GINA | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7323458346 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0204X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
No ID Information.