1083658850 NPI number — CARDIAC TESTING CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083658850 NPI number — CARDIAC TESTING CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARDIAC TESTING CENTER
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:
1083658850
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 23307
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07189-0307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-598-5200
Provider Business Mailing Address Fax Number:
908-273-6037

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29 SOUTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW PROVIDENCE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07974-1940
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-665-9500
Provider Business Practice Location Address Fax Number:
908-665-1811
Provider Enumeration Date:
06/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FARRY
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
908-665-9500

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3251004 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110046434 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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