Provider Demographics
NPI:1083658850
Name:CARDIAC TESTING CENTER
Entity Type:Organization
Organization Name:CARDIAC TESTING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:FARRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-665-9500
Mailing Address - Street 1:PO BOX 23307
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07189-0307
Mailing Address - Country:US
Mailing Address - Phone:908-598-5200
Mailing Address - Fax:908-273-6037
Practice Address - Street 1:29 SOUTH ST
Practice Address - Street 2:
Practice Address - City:NEW PROVIDENCE
Practice Address - State:NJ
Practice Address - Zip Code:07974-1940
Practice Address - Country:US
Practice Address - Phone:908-665-9500
Practice Address - Fax:908-665-1811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3251004Medicaid
NJ110046434OtherRAILROAD MEDICARE
NJ3251004Medicaid