Provider Demographics
NPI:1497062772
Name:CARDIOMD
Entity Type:Organization
Organization Name:CARDIOMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHANDRESHWAR
Authorized Official - Middle Name:N
Authorized Official - Last Name:SHAHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACC
Authorized Official - Phone:908-864-4027
Mailing Address - Street 1:1130 US HIGHWAY 202
Mailing Address - Street 2:BUILDING E
Mailing Address - City:RARITAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08869-1490
Mailing Address - Country:US
Mailing Address - Phone:908-864-4027
Mailing Address - Fax:908-864-4029
Practice Address - Street 1:1130 ROUTE 202
Practice Address - Street 2:BUILDING E
Practice Address - City:RARITAN
Practice Address - State:NJ
Practice Address - Zip Code:08869-1490
Practice Address - Country:US
Practice Address - Phone:908-864-4027
Practice Address - Fax:908-864-4029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-08
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07079900207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH09685Medicare UPIN