Provider Demographics
NPI:1225187883
Name:JERSEY SHORE CARDIOTHORACIC AND VASCULAR SURGERY ASSOCIATES PA
Entity Type:Organization
Organization Name:JERSEY SHORE CARDIOTHORACIC AND VASCULAR SURGERY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-775-9077
Mailing Address - Street 1:301 BINGHAM AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-4762
Mailing Address - Country:US
Mailing Address - Phone:732-775-9077
Mailing Address - Fax:732-988-7852
Practice Address - Street 1:301 BINGHAM AVE
Practice Address - Street 2:SUITE A
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-4762
Practice Address - Country:US
Practice Address - Phone:732-775-9077
Practice Address - Fax:732-988-7852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA40670208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ602608Medicare ID - Type Unspecified