Provider Demographics
NPI:1477673549
Name:CARDIO VASCULAR ASSOCIATES OF N.J., P.A.
Entity Type:Organization
Organization Name:CARDIO VASCULAR ASSOCIATES OF N.J., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:
Authorized Official - Last Name:O'CALLAGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-364-1444
Mailing Address - Street 1:112 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-5336
Mailing Address - Country:US
Mailing Address - Phone:973-364-1444
Mailing Address - Fax:973-364-0101
Practice Address - Street 1:112 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-5336
Practice Address - Country:US
Practice Address - Phone:973-364-1444
Practice Address - Fax:973-364-0101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02866900174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ657692Medicare ID - Type Unspecified