Organization Active NPI

Hackensack Vascular Specialists LLC

  • Specialist
  • Hackensack, NJ
National Provider Identifier
1063840239
Registry record updated Dec 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
25MB08446100 Issued in NJ
Legal business name
HACKENSACK VASCULAR SPECIALISTS LLC
Practice address
211 Essex St Ste 102
Hackensack, NJ 07601-3244
Phone
(201) 487-8882
Fax
(201) 487-0943
NPI assigned
Oct 24, 2013
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Dr. Gregory Simonian, MDNPI 1528017944
Title
President
Phone
(201) 487-8882

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20131220000045 NJ Part B Supplier - Clinic/Group Practice 5597992412 Receives reassigned benefits from 4 practitioners
Practice locations: Hackensack, NJ

National Provider Directory

National Provider Directory

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 25MB08446100 NJ Primary

Addresses

NPPES NPI Registry

Primary practice location

211 Essex St Ste 102
Hackensack, NJ 07601-3244

Mailing address

211 Essex St Ste 102
Hackensack, NJ 07601-3244
Phone (201) 487-8882

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 17, 2013.

{
    "created_epoch": "1382572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1387238400000",
    "number": "1063840239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 ESSEX ST STE 102",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076013244",
            "telephone_number": "201-487-8882",
            "fax_number": "201-487-0943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 ESSEX ST STE 102",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076013244",
            "telephone_number": "201-487-8882",
            "fax_number": "201-487-0943"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HACKENSACK VASCULAR SPECIALISTS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-24",
        "last_updated": "2013-12-17",
        "status": "A",
        "authorized_official_last_name": "SIMONIAN",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "201-487-8882",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "NJ",
            "license": "25MB08446100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hackensack, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.