Provider Demographics
NPI:1609274810
Name:PREMIER SURGICAL & PREMIER VEIN CENTER LLC
Entity type:Organization
Organization Name:PREMIER SURGICAL & PREMIER VEIN CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JARROD
Authorized Official - Middle Name:
Authorized Official - Last Name:KAUFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-262-1600
Mailing Address - Street 1:525 ROUTE 70 EAST SUITE 1B
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-4022
Mailing Address - Country:US
Mailing Address - Phone:732-262-1600
Mailing Address - Fax:732-262-1606
Practice Address - Street 1:525 ROUTE 70 EAST SUITE 1B
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-4022
Practice Address - Country:US
Practice Address - Phone:732-262-1600
Practice Address - Fax:732-262-1606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07404200208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty