Provider Demographics
NPI:1306421516
Name:MODERN VASCULAR, PLLC
Entity type:Organization
Organization Name:MODERN VASCULAR, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRITTNY
Authorized Official - Middle Name:WILIAMS
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-545-4365
Mailing Address - Street 1:159 DANBURY RD UNIT 105
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-3235
Mailing Address - Country:US
Mailing Address - Phone:203-291-5335
Mailing Address - Fax:
Practice Address - Street 1:159 DANBURY RD UNIT 105
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-3235
Practice Address - Country:US
Practice Address - Phone:203-291-5335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-10
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty