1447200431 NPI number — CEDARBROOK CARDIOLOGY LLC

Table of content: (NPI 1447200431)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447200431 NPI number — CEDARBROOK CARDIOLOGY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CEDARBROOK CARDIOLOGY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447200431
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
902 OAK TREE AVE
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
SOUTH PLAINFIELD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07080-5136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-756-1703
Provider Business Mailing Address Fax Number:
908-756-1793

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
902 OAK TREE AVE
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
SOUTH PLAINFIELD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07080-5136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-756-1703
Provider Business Practice Location Address Fax Number:
908-756-1793
Provider Enumeration Date:
05/11/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RAKLA
Authorized Official First Name:
YOUNUS
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
908-756-1703

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MA43667 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6678408 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".