Basic Information
| Provider Information | |||||||||
| NPI: | 1659348696 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURNS | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 MADISON AVENUE | ||||||||
| Address2: | MID-ATLANTIC SURGICAL ASSOCIATES | ||||||||
| City: | MORRISTOWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07960 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9739717300 | ||||||||
| FaxNumber: | 9739847019 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 TRENTON RD (DEBORAH HEART & LUNG CENTER) - | ||||||||
| Address2: | MID-ATLANTIC SURGICAL ASSOCIATES | ||||||||
| City: | BROWNS MILLS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9739717300 | ||||||||
| FaxNumber: | 9739847019 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2006 | ||||||||
| LastUpdateDate: | 08/14/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 25MA07298800 | NJ | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 208G00000X | MA072988 | NJ | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 8623104 | 05 | NJ | MEDICAID |