Basic Information
| Provider Information | |||||||||
| NPI: | 1073721080 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HACKENSACK VASCULAR CENTER, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 563 | ||||||||
| Address2: | |||||||||
| City: | SADDLE RIVER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074580563 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2019969255 | ||||||||
| FaxNumber: | 2019969243 | ||||||||
| Practice Location | |||||||||
| Address1: | 176 SUMMIT AVE | ||||||||
| Address2: | |||||||||
| City: | HACKENSACK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076011310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2019969255 | ||||||||
| FaxNumber: | 2019969243 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2007 | ||||||||
| LastUpdateDate: | 02/29/2008 | ||||||||
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| AuthorizedOfficialLastName: | MULKAY | ||||||||
| AuthorizedOfficialFirstName: | ANGEL | ||||||||
| AuthorizedOfficialMiddleName: | JESUS | ||||||||
| AuthorizedOfficialTitleorPosition: | CARDIOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 2019969255 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 25MA06378600 | NJ | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.