Basic Information
| Provider Information | |||||||||
| NPI: | 1154768315 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ABSECON ISLAND CARDIOLOGY, LLC | ||||||||
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| Address1: | 200 S NEW RD | ||||||||
| Address2: | P.O BOX 5 | ||||||||
| City: | ABSECON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082012530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6096777776 | ||||||||
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| Address1: | 200 S NEW RD | ||||||||
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| City: | ABSECON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082012530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6096777776 | ||||||||
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| ProviderEnumerationDate: | 05/29/2013 | ||||||||
| LastUpdateDate: | 05/29/2013 | ||||||||
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| AuthorizedOfficialLastName: | DESAI | ||||||||
| AuthorizedOfficialFirstName: | RASHMIKANT | ||||||||
| AuthorizedOfficialMiddleName: | SUMANTLAL | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6096777776 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.