Provider Demographics
NPI:1124189519
Name:BUCKS COUNTY CARDIOTHORACIC SURGERY, P.C.
Entity Type:Organization
Organization Name:BUCKS COUNTY CARDIOTHORACIC SURGERY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-483-5490
Mailing Address - Street 1:2370 YORK RD STE A9D
Mailing Address - Street 2:
Mailing Address - City:JAMISON
Mailing Address - State:PA
Mailing Address - Zip Code:18929-1031
Mailing Address - Country:US
Mailing Address - Phone:267-483-5490
Mailing Address - Fax:267-483-5496
Practice Address - Street 1:120 WHITE HORSE PIKE STE 103
Practice Address - Street 2:
Practice Address - City:HADDON HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08035-1938
Practice Address - Country:US
Practice Address - Phone:267-483-5490
Practice Address - Fax:267-483-5504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0094331Medicaid
CJ2845OtherMEDICARE RR
PA0019064830005Medicaid
NJ0094331Medicaid
NJ093562Medicare PIN