Provider Demographics
NPI:1740386994
Name:CARDIAC CARE CENTER LLC
Entity Type:Organization
Organization Name:CARDIAC CARE CENTER LLC
Other - Org Name:CARDIAC CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARISTOTELIS
Authorized Official - Middle Name:
Authorized Official - Last Name:VLAHOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-741-7400
Mailing Address - Street 1:PO BOX 7580
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702
Mailing Address - Country:US
Mailing Address - Phone:732-741-7400
Mailing Address - Fax:732-219-7638
Practice Address - Street 1:21 N GILBERT ST
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07701-4950
Practice Address - Country:US
Practice Address - Phone:732-741-7400
Practice Address - Fax:732-219-7638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25000MA6091600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ901275Medicare UPIN