Provider Demographics
NPI:1215039557
Name:ENGLEWOOD CARDIOLOGY CONSULTANTS
Entity Type:Organization
Organization Name:ENGLEWOOD CARDIOLOGY CONSULTANTS
Other - Org Name:ENGLEWOOD CARDIOLOGY CONSULTANTS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:B
Authorized Official - Last Name:LEBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-569-4901
Mailing Address - Street 1:177 N DEAN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2533
Mailing Address - Country:US
Mailing Address - Phone:201-569-4901
Mailing Address - Fax:201-569-6111
Practice Address - Street 1:177 N DEAN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2533
Practice Address - Country:US
Practice Address - Phone:201-569-4901
Practice Address - Fax:201-569-6111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3125301Medicaid
NJ3125301Medicaid