Organization
BROADWAY COMPREHENSIVE VEIN CENTER P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DALLAS BROADWAY M.D. (PRESIDENT)
(732) 235-0147
Entity
Organization
Contact information
Practice address
360 SPRINGFIELD AVE, SUITE 302D, SUMMIT, NJ 07901-4608
(973) 969-6400
(609) 949-5555
Mailing address
171 GREAT NECK RD, APT 3E, GREAT NECK, NY 11021-3302
(917) 817-2802
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
25MA09187400
NJ
Other
Enumeration date
04/02/2013
Last updated
10/07/2014
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