# COSMETIC VEIN CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376662312
- **Authorized official:** MRS. DIANE FRANCES CHUBACK PH.D. (PRACTICE ADMINISTRATOR)
- **Authorized official phone:** (201) 445-8820

## Contact information

- **Practice address:** 265 ACKERMAN AVE, SUITE 203, RIDGEWOOD, NJ 07450-4200
- **Practice address phone:** (201) 445-8820
- **Practice address fax:** (201) 445-8850
- **Mailing address:** 265 ACKERMAN AVENUE, SUITE 203, RIDGEWOOD, NJ 07450-0745
- **Mailing address phone:** (201) 445-8820
- **Mailing address fax:** (201) 445-8850

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | — | NULL | Yes |
| 2086S0129X | Vascular Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/29/2007
- **Last updated:** 10/04/2007