Provider Demographics
NPI:1104115393
Name:SKS VASCULAR CENTER LLC
Entity type:Organization
Organization Name:SKS VASCULAR CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:O
Authorized Official - Last Name:SANTANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD,FACC
Authorized Official - Phone:201-854-0055
Mailing Address - Street 1:425 70TH ST
Mailing Address - Street 2:
Mailing Address - City:GUTTENBERG
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-2417
Mailing Address - Country:US
Mailing Address - Phone:201-854-0055
Mailing Address - Fax:201-854-2633
Practice Address - Street 1:427 70TH ST
Practice Address - Street 2:
Practice Address - City:GUTTENBERG
Practice Address - State:NJ
Practice Address - Zip Code:07093-2417
Practice Address - Country:US
Practice Address - Phone:201-854-0055
Practice Address - Fax:201-854-2633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-29
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05225300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty