1790807766 NPI number — CARDIAC & ENDOVASCULAR ASSOCIATES, LLC

Table of content: (NPI 1790807766)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790807766 NPI number — CARDIAC & ENDOVASCULAR ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARDIAC & ENDOVASCULAR ASSOCIATES, 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:
1790807766
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1124 E RIDGEWOOD AVE
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
RIDGEWOOD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07450-3915
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-689-8070
Provider Business Mailing Address Fax Number:
201-689-9404

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1124 E RIDGEWOOD AVE
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
RIDGEWOOD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07450-3915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-689-8070
Provider Business Practice Location Address Fax Number:
201-689-9404
Provider Enumeration Date:
04/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STRAIN
Authorized Official First Name:
JANET
Authorized Official Middle Name:
ELIZABETH
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
201-689-8070

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00800239 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6341101 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com