Provider Demographics
NPI:1255468922
Name:CARDIAC DIAGNOSTIC CENTER OF SOUTHERN NEW JERSEY
Entity Type:Organization
Organization Name:CARDIAC DIAGNOSTIC CENTER OF SOUTHERN NEW JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:W
Authorized Official - Last Name:NORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-428-5321
Mailing Address - Street 1:1840 FRONTAGE ROAD MARK 70 SUITE 104
Mailing Address - Street 2:CARDIAC DIAGNOSTIC CENTER OF SOUTHERN NEW JERSEY
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-2228
Mailing Address - Country:US
Mailing Address - Phone:856-428-5321
Mailing Address - Fax:856-428-5321
Practice Address - Street 1:1840 FRONTAGE ROAD MARK 70 SUITE 104
Practice Address - Street 2:CARDIAC DIAGNOSTIC CENTER OF SOUTHERN NEW JERSEY
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-2228
Practice Address - Country:US
Practice Address - Phone:856-428-5321
Practice Address - Fax:856-428-5321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA428008Medicare ID - Type Unspecified