# NEW JERSEY PHLEBOLOGY PC

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

## Provider details

- **NPI number:** 1790056521
- **Authorized official:** J THEODORE KING MD (OWNER)
- **Authorized official phone:** (630) 725-2768

## Contact information

- **Practice address:** 55 MADISON AVE, SUITE 400, MORRISTOWN, NJ 07960-7337
- **Practice address phone:** (630) 725-2730
- **Practice address fax:** (877) 219-4810
- **Mailing address:** 1901 BUTTERFIELD RD, 220, DOWNERS GROVE, IL 60515-7915
- **Mailing address phone:** (630) 725-2768
- **Mailing address fax:** (877) 219-4810

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 202K00000X | Phlebology Physician | — | NULL | Yes |
| 202K00000X | Phlebology Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/25/2012
- **Last updated:** 01/25/2012