Provider Demographics
NPI:1619030780
Name:CARDIAC CARE OF NORTH JERSEY LLC
Entity Type:Organization
Organization Name:CARDIAC CARE OF NORTH JERSEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLER
Authorized Official - Prefix:
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-994-0069
Mailing Address - Street 1:340 E NORTHFIELD RD
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-4892
Mailing Address - Country:US
Mailing Address - Phone:973-994-0069
Mailing Address - Fax:973-994-0567
Practice Address - Street 1:340 E NORTHFIELD RD
Practice Address - Street 2:SUITE 2C
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-4892
Practice Address - Country:US
Practice Address - Phone:973-994-0069
Practice Address - Fax:973-994-0567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8970904Medicaid
NJ8970904Medicaid