Broadway Vascular LLC

Primary specialty

Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X

Legal business name

BROADWAY VASCULAR LLC

Practice address

106 Apple St Ste 200a
Tinton Falls, NJ 07724-2670

Phone

(732) 475-0880

Fax

(732) 475-0881

NPI assigned

Aug 29, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dallas Broadway, MD

Title

Owner

Phone

(917) 780-8575

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1409270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656547200000",
    "number": "1235539081",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 APPLE ST STE 200A",
            "city": "TINTON FALLS",
            "state": "NJ",
            "postal_code": "077242670",
            "telephone_number": "732-475-0880",
            "fax_number": "732-475-0881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 APPLE ST STE 200A",
            "city": "TINTON FALLS",
            "state": "NJ",
            "postal_code": "077242670",
            "telephone_number": "732-475-0880",
            "fax_number": "732-475-0881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADWAY VASCULAR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-29",
        "last_updated": "2022-06-30",
        "certification_date": "2022-06-30",
        "status": "A",
        "authorized_official_last_name": "BROADWAY",
        "authorized_official_first_name": "DALLAS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "917-780-8575",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "NJ",
            "license": "25MA09187400",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dolores Eaton Brennan
• Paul Frederick Brenner, DSW
• Briana'S Way Day Care
• Leonid Brimshan
• Lauren Brinez, MS, LPC
• Laura Brockman, PSY.D
• Nicole Leigh Brody, M.S.ED, BCBA
• Gary M Brousell, D.D.S.
• Kevin S Brown, PA
• Michelle Leivette Bryant, DDS

• Vascular & Interventional Radiology Physician in Tinton Falls, NJ
• Providers in Tinton Falls, NJ by specialty
• Vascular & Interventional Radiology Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.