Basic Information
| Provider Information | |||||||||
| NPI: | 1336277169 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARDIOVASCULAR GROUP-NJ LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 BARTOL AVE | ||||||||
| Address2: | SUITE 10 | ||||||||
| City: | RIDLEY PARK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190782214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105210150 | ||||||||
| FaxNumber: | 6105216493 | ||||||||
| Practice Location | |||||||||
| Address1: | 545 BECKETT RD | ||||||||
| Address2: | SUITE 101B | ||||||||
| City: | LOGAN TOWNSHIP | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080851547 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105210150 | ||||||||
| FaxNumber: | 6105216493 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2007 | ||||||||
| LastUpdateDate: | 09/24/2007 | ||||||||
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| AuthorizedOfficialLastName: | GITTER | ||||||||
| AuthorizedOfficialFirstName: | HOWARD | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6105210150 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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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.