Provider Demographics
NPI:1427362888
Name:CARDIOVASCULAR GROUP NJ LLC
Entity Type:Organization
Organization Name:CARDIOVASCULAR GROUP NJ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-521-0150
Mailing Address - Street 1:1 BARTOL AVE
Mailing Address - Street 2:STE 10
Mailing Address - City:RIDLEY PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19078-2214
Mailing Address - Country:US
Mailing Address - Phone:610-521-0150
Mailing Address - Fax:610-521-6493
Practice Address - Street 1:230 LAUREL HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-3634
Practice Address - Country:US
Practice Address - Phone:610-521-0150
Practice Address - Fax:610-521-6493
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARDIOVASCULAR GROUP NJ LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty