Provider Demographics
NPI:1770641532
Name:MEDICOR CARDIOLOGY, PA
Entity Type:Organization
Organization Name:MEDICOR CARDIOLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLISON-MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-243-5004
Mailing Address - Street 1:225 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-3060
Mailing Address - Country:US
Mailing Address - Phone:908-526-8668
Mailing Address - Fax:908-231-6781
Practice Address - Street 1:225 JACKSON ST
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-3060
Practice Address - Country:US
Practice Address - Phone:908-526-8668
Practice Address - Fax:908-231-6781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2935902Medicaid
NJ540939Medicare ID - Type UnspecifiedGROUP NUMBER