Provider Demographics
NPI:1174601462
Name:ADVANCED VEIN CARE, LLC
Entity type:Organization
Organization Name:ADVANCED VEIN CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:KACHMAR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:732-269-1133
Mailing Address - Street 1:355 ATLANTIC CITY BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BAYVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08721-1292
Mailing Address - Country:US
Mailing Address - Phone:732-269-1133
Mailing Address - Fax:732-269-7675
Practice Address - Street 1:355 ATLANTIC CITY BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:BAYVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08721-1292
Practice Address - Country:US
Practice Address - Phone:732-269-1133
Practice Address - Fax:732-269-7675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2086S0129X
NJ25MD00154800213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Not Answered213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T45638Medicare UPIN
NJ511701Medicare ID - Type Unspecified