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Organization
BROADWAY VASCULAR LLC
Active
Organization
BROADWAY VASCULAR LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DALLAS BROADWAY MD (OWNER)
(917) 780-8575
Entity
Organization
Contact information
Practice address
106 APPLE ST STE 200A, TINTON FALLS, NJ 07724-2670
(732) 475-0880
(732) 475-0881
Mailing address
106 APPLE ST STE 200A, TINTON FALLS, NJ 07724-2670
(732) 475-0880
(732) 475-0881
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
Primary
—
—
261QR0200X
Radiology Clinic/Center
25MA09187400
NJ
Other
Enumeration date
08/29/2014
Last updated
06/30/2022
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