Provider Demographics
NPI:1467670224
Name:COMMUNITY HOSPITAL GROUP, INC
Entity Type:Organization
Organization Name:COMMUNITY HOSPITAL GROUP, INC
Other - Org Name:JFK CARDIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-492-7474
Mailing Address - Street 1:3600 ROUTE 66 FL 3
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-2645
Mailing Address - Country:US
Mailing Address - Phone:888-571-5280
Mailing Address - Fax:732-922-0914
Practice Address - Street 1:65 JAMES ST
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3947
Practice Address - Country:US
Practice Address - Phone:732-632-1571
Practice Address - Fax:732-632-1644
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HOSPITAL GROUP, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-24
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22293174400000X
207RC0000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0010855Medicaid
NJ528626Medicare PIN