Provider Demographics
NPI:1679732531
Name:AAA VASCULAR CARE PLLC
Entity type:Organization
Organization Name:AAA VASCULAR CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TOUFIC
Authorized Official - Middle Name:KASSEM
Authorized Official - Last Name:SAFA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-466-6760
Mailing Address - Street 1:PO BOX 9401
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11555-9401
Mailing Address - Country:US
Mailing Address - Phone:516-466-6760
Mailing Address - Fax:516-466-6776
Practice Address - Street 1:900 NORTHERN BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5302
Practice Address - Country:US
Practice Address - Phone:516-466-6760
Practice Address - Fax:516-466-6776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2012432086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A100000100Medicare PIN