1043264401 NPI number — THE HEART CENTER, PC

Table of content: (NPI 1043264401)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043264401 NPI number — THE HEART CENTER, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE HEART CENTER, PC
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:
1043264401
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 US HIGHWAY 9
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOWELL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07731-3301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-389-0266
Provider Business Mailing Address Fax Number:
732-389-2294

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
117 ROUTE 35
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EATONTOWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07724-3478
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-389-0266
Provider Business Practice Location Address Fax Number:
732-389-2294
Provider Enumeration Date:
05/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CLEMENTE
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
732-389-0266

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  25MA05258900 , 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: 01115493 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3413900 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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