Provider Demographics
NPI:1033184718
Name:CARDIOVASCULAR ASSOCIATES OF MOUNTAINSIDE PA
Entity Type:Organization
Organization Name:CARDIOVASCULAR ASSOCIATES OF MOUNTAINSIDE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:GENIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DILIBERTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-654-1200
Mailing Address - Street 1:1216 RTE 22 W
Mailing Address - Street 2:
Mailing Address - City:MOUNTAINSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07092
Mailing Address - Country:US
Mailing Address - Phone:908-654-1200
Mailing Address - Fax:908-654-1206
Practice Address - Street 1:1216 RTE 22 W
Practice Address - Street 2:
Practice Address - City:MOUNTAINSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07092
Practice Address - Country:US
Practice Address - Phone:908-654-1200
Practice Address - Fax:908-654-1206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-17
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB044592207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ054354Medicare PIN