Basic Information
| Provider Information | |||||||||
| NPI: | 1487974937 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DEBORAH HEART AND LUNG HOSPITAL CTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 43 HADDON CT | ||||||||
| Address2: | |||||||||
| City: | PENNINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 085345196 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7324075196 | ||||||||
| FaxNumber: | 7182287574 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 TRENTON RD | ||||||||
| Address2: | DEBORAH HEART AND LUNG | ||||||||
| City: | BROWNS MILLS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080151705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098936611 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2010 | ||||||||
| LastUpdateDate: | 06/08/2010 | ||||||||
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| AuthorizedOfficialLastName: | MCNAMARA | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | INTERIM CHAIRMAN OF MEDICINCE | ||||||||
| AuthorizedOfficialTelephone: | 6098936611 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 284300000X | 25MA08712700 | NJ | Y | Hospitals | Special Hospital |
ID Information
| ID | Type | State | Issuer | Description | 25MA08712700 | 01 | NJ | NJ MEDICAL LICENSE NO. | OTHER |