Provider Demographics
NPI:1184668964
Name:NORTH JERSEY THORACIC AND CARDIOVASCULAR SURGICAL OFFICES PA
Entity Type:Organization
Organization Name:NORTH JERSEY THORACIC AND CARDIOVASCULAR SURGICAL OFFICES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:HERMOGENES
Authorized Official - Middle Name:L
Authorized Official - Last Name:CIOCON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-779-2270
Mailing Address - Street 1:871 ALLWOOD ROAD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012
Mailing Address - Country:US
Mailing Address - Phone:973-779-2270
Mailing Address - Fax:973-779-5250
Practice Address - Street 1:871 ALLWOOD ROAD
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012
Practice Address - Country:US
Practice Address - Phone:973-779-2270
Practice Address - Fax:973-779-5250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2694301Medicaid
NJ2694301Medicaid