Provider Demographics
NPI:1619000262
Name:ELECTROPHYSIOLOGY ASSOCIATES OF NORTHERN NEW JERSEY PA PC
Entity Type:Organization
Organization Name:ELECTROPHYSIOLOGY ASSOCIATES OF NORTHERN NEW JERSEY PA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-996-2997
Mailing Address - Street 1:20 PROSPECT AVE
Mailing Address - Street 2:SUITE 701
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1997
Mailing Address - Country:US
Mailing Address - Phone:201-996-2997
Mailing Address - Fax:201-996-2571
Practice Address - Street 1:20 PROSPECT AVE
Practice Address - Street 2:SUITE 701
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1997
Practice Address - Country:US
Practice Address - Phone:201-996-2997
Practice Address - Fax:201-996-2571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05047300207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3108580OtherAETNA HMO GROUP #
NJ5792488OtherAETNA PPO GROUP #
NJCJ2835OtherRAILROAD MEDICARE GROUP #
NJ3108580OtherAETNA HMO GROUP #
NYWYBXT1Medicare PIN