Basic Information
| Provider Information | |||||||||
| NPI: | 1669893889 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GENERAL VASCULAR SURGICAL SPECIALISTS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17 W RED BANK AVE | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | WOODBURY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080961630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8568488242 | ||||||||
| FaxNumber: | 8563846015 | ||||||||
| Practice Location | |||||||||
| Address1: | 17 W RED BANK AVE | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | WOODBURY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080961630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8568488242 | ||||||||
| FaxNumber: | 8563846015 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2013 | ||||||||
| LastUpdateDate: | 12/16/2013 | ||||||||
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| AuthorizedOfficialLastName: | PILLA | ||||||||
| AuthorizedOfficialFirstName: | TIMOTHY | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8568488242 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | INSPIRA HEALTH NETWORK MEDICAL GROUP | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 208600000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.