Provider Demographics
NPI:1225580830
Name:DIAGNOSTIC HEART CENTER OF CENTRAL NJ
Entity Type:Organization
Organization Name:DIAGNOSTIC HEART CENTER OF CENTRAL NJ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRIS
Authorized Official - Middle Name:ROBIN
Authorized Official - Last Name:MENTLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-770-8671
Mailing Address - Street 1:555 IRON BRIDGE RD
Mailing Address - Street 2:SUITE 16
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2975
Mailing Address - Country:US
Mailing Address - Phone:732-683-9955
Mailing Address - Fax:732-683-1044
Practice Address - Street 1:555 IRON BRIDGE RD
Practice Address - Street 2:SUITE 16
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2975
Practice Address - Country:US
Practice Address - Phone:732-683-9955
Practice Address - Fax:732-683-1044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-30
Last Update Date:2016-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA64455261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G60558Medicare UPIN