Provider Demographics
NPI:1114066206
Name:OLD PERTH CARDIOLOGY GROUP PA
Entity Type:Organization
Organization Name:OLD PERTH CARDIOLOGY GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIARAMIDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-339-1700
Mailing Address - Street 1:PO BOX 79
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-0079
Mailing Address - Country:US
Mailing Address - Phone:201-339-1700
Mailing Address - Fax:201-339-6972
Practice Address - Street 1:280 AMBOY AVE
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-2426
Practice Address - Country:US
Practice Address - Phone:201-339-1700
Practice Address - Fax:201-339-6972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA42221174400000X
NJMA05442900174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ064846Medicare ID - Type Unspecified