Provider Demographics
NPI:1174652077
Name:CARDIAC, THORACIC AND VASCULAR SURGICAL ASSOCIATE, P.A.
Entity Type:Organization
Organization Name:CARDIAC, THORACIC AND VASCULAR SURGICAL ASSOCIATE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:N
Authorized Official - Last Name:HOLWITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-743-9900
Mailing Address - Street 1:123 HIGHLAND AVE
Mailing Address - Street 2:SUITE G2
Mailing Address - City:GLEN RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07028-1527
Mailing Address - Country:US
Mailing Address - Phone:973-743-9900
Mailing Address - Fax:973-743-3222
Practice Address - Street 1:123 HIGHLAND AVE
Practice Address - Street 2:SUITE G2
Practice Address - City:GLEN RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07028-1527
Practice Address - Country:US
Practice Address - Phone:973-743-9900
Practice Address - Fax:973-743-3222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA37001208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ526341Medicare ID - Type UnspecifiedPROVIDER NUMBER