Basic Information
| Provider Information | |||||||||
| NPI: | 1740536275 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HACKENSACK INTERVENTIONAL INSTITUTE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 449 | ||||||||
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| City: | RIDGEWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074510449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2019969255 | ||||||||
| FaxNumber: | 2019969257 | ||||||||
| Practice Location | |||||||||
| Address1: | 493 ESSEX ST | ||||||||
| Address2: | |||||||||
| City: | HACKENSACK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076011215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2019969244 | ||||||||
| FaxNumber: | 2019969243 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2012 | ||||||||
| LastUpdateDate: | 08/02/2012 | ||||||||
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| AuthorizedOfficialLastName: | MULKAY | ||||||||
| AuthorizedOfficialFirstName: | ANGEL | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2019969255 | ||||||||
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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 | 207RI0011X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
No ID Information.