Provider Demographics
NPI:1730293200
Name:CARDIAC NUCLEAR DIAGNOSTIC CENTER OF OCEAN COUNTY
Entity Type:Organization
Organization Name:CARDIAC NUCLEAR DIAGNOSTIC CENTER OF OCEAN COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRECA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-341-3948
Mailing Address - Street 1:81 ROUTE 37 W
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-6405
Mailing Address - Country:US
Mailing Address - Phone:732-341-3948
Mailing Address - Fax:
Practice Address - Street 1:81 ROUTE 37 W
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6405
Practice Address - Country:US
Practice Address - Phone:732-341-3948
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3298604Medicaid
NJ555342Medicare PIN