Provider Demographics
NPI:1629391180
Name:CARDIOLOGY AND VASCULAR CONSULTANTS OF NEW JERSEY
Entity Type:Organization
Organization Name:CARDIOLOGY AND VASCULAR CONSULTANTS OF NEW JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KHALIL
Authorized Official - Middle Name:A
Authorized Official - Last Name:KAID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-581-0834
Mailing Address - Street 1:2168 MILLBURN AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-2640
Mailing Address - Country:US
Mailing Address - Phone:800-243-5854
Mailing Address - Fax:206-824-9510
Practice Address - Street 1:2168 MILLBURN AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-2640
Practice Address - Country:US
Practice Address - Phone:973-762-3353
Practice Address - Fax:973-762-3370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-11
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08008500207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0249327Medicaid
NJDQ5886OtherRAILROAD MEDICARE
NJDQ5886OtherRAILROAD MEDICARE