Basic Information
| Provider Information | |||||||||
| NPI: | 1629391180 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARDIOLOGY AND VASCULAR CONSULTANTS OF NEW JERSEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2168 MILLBURN AVE | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | MAPLEWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070402640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002435854 | ||||||||
| FaxNumber: | 2068249510 | ||||||||
| Practice Location | |||||||||
| Address1: | 2168 MILLBURN AVE | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | MAPLEWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070402640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737623353 | ||||||||
| FaxNumber: | 9737623370 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2010 | ||||||||
| LastUpdateDate: | 04/02/2015 | ||||||||
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| AuthorizedOfficialLastName: | KAID | ||||||||
| AuthorizedOfficialFirstName: | KHALIL | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3475810834 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 25MA08008500 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 0249327 | 05 | NJ | MEDICAID | DQ5886 | 01 | NJ | RAILROAD MEDICARE | OTHER |