Innovative Vascular Group

Primary specialty

SpecialistTaxonomy code 174400000X

License

25MA06756800 Issued in NJ

Legal business name

INNOVATIVE VASCULAR GROUP

Practice address

142 Highway 35
Suite 106a
Eatontown, NJ 07724-3427

Phone

(732) 380-1222

NPI assigned

Jun 4, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Alfonso Ciervo, MDNPI 1457346918

Title

Owner

Phone

(732) 380-1222

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

Practitioners 1

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

• Alfonso Ciervo, MD

  • Specialist
  • Eatontown, NJ
  • NPI 1457346918
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1149379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189641600000",
    "number": "1477591006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 CRAPE MYRTLE DR",
            "city": "HOLMDEL",
            "state": "NJ",
            "postal_code": "077331529",
            "telephone_number": "732-380-1222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "142 HIGHWAY 35",
            "address_2": "SUITE 106A",
            "city": "EATONTOWN",
            "state": "NJ",
            "postal_code": "077243427",
            "telephone_number": "732-380-1222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE VASCULAR GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-04",
        "last_updated": "2007-09-13",
        "status": "A",
        "authorized_official_last_name": "CIERVO",
        "authorized_official_first_name": "ALFONSO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "732-380-1222",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "NJ",
            "license": "25MA06756800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH GROUP #",
            "identifier": "2371188001",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GROUP#",
            "identifier": "DC4342",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anzhelika Ihnatenko, OTR/L
• Matthew C Ihnken, LSW
• Alice Sherrington Imhof
• Kelvin Imhomoh
• Innovative Life of New Jersey
• Integrated Care Concepts & Consultation, LLC
• Integrated Care Consulting LLC
• Integrated Psychiatric Services LLC
• Internal Medicine Associates of Monmouth, PC
• Intuitively Nourished LLC

• Specialist in Eatontown, NJ
• Providers in Eatontown, NJ by specialty
• Specialist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2007; 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.