Provider Demographics
NPI:1710917729
Name:ELECTROPHYSIOLOGY ASSOCIATES, PA
Entity Type:Organization
Organization Name:ELECTROPHYSIOLOGY ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:WINTERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-971-4261
Mailing Address - Street 1:98 FORD RD
Mailing Address - Street 2:SUITE 3-H
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-1374
Mailing Address - Country:US
Mailing Address - Phone:973-625-3366
Mailing Address - Fax:973-625-0349
Practice Address - Street 1:100 MADISON AVE
Practice Address - Street 2:BOX 5
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6136
Practice Address - Country:US
Practice Address - Phone:973-971-4261
Practice Address - Fax:973-290-7253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA051127207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6313108Medicaid
NJ534724Medicare ID - Type UnspecifiedGROUP MEDICARE NMBR