Provider Demographics
NPI:1518966894
Name:MORRISTOWN CARDIOLOGY ASSOC PA
Entity Type:Organization
Organization Name:MORRISTOWN CARDIOLOGY ASSOC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MIERZEJEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-775-4629
Mailing Address - Street 1:182 SOUTH ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-5377
Mailing Address - Country:US
Mailing Address - Phone:973-267-3944
Mailing Address - Fax:973-455-0399
Practice Address - Street 1:182 SOUTH ST
Practice Address - Street 2:SUITE 5
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-5377
Practice Address - Country:US
Practice Address - Phone:973-267-3944
Practice Address - Fax:973-455-0399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2671301Medicaid
PA01906080Medicaid
MO81413Medicare ID - Type Unspecified