Provider Demographics
NPI:1558170019
Name:VANTAGE MEDICAL ASSOCIATES NJ PC
Entity type:Organization
Organization Name:VANTAGE MEDICAL ASSOCIATES NJ PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JUREWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-702-7222
Mailing Address - Street 1:1612 CENTRAL AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-4002
Mailing Address - Country:US
Mailing Address - Phone:718-970-8700
Mailing Address - Fax:
Practice Address - Street 1:680 BROADWAY STE 100
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07514-1526
Practice Address - Country:US
Practice Address - Phone:678-702-7222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty