Basic Information
| Provider Information | |||||||||
| NPI: | 1821041732 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DEBORAH CARDIOVASCULAR GROUP, P.C. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | ADVANCED HEART, LUNG AND VASCULAR CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 200 TRENTON RD | ||||||||
| Address2: | |||||||||
| City: | BROWNS MILLS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080151705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098931200 | ||||||||
| FaxNumber: | 6097350175 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 TRENTON RD | ||||||||
| Address2: | |||||||||
| City: | BROWNS MILLS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080151705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098931200 | ||||||||
| FaxNumber: | 6097350175 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | LEIDY | ||||||||
| AuthorizedOfficialFirstName: | R.GRANT | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | TREASURER SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 6098931200 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.