Provider Demographics
NPI:1821041732
Name:DEBORAH CARDIOVASCULAR GROUP, P.C.
Entity Type:Organization
Organization Name:DEBORAH CARDIOVASCULAR GROUP, P.C.
Other - Org Name:ADVANCED HEART, LUNG AND VASCULAR CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:R.GRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:LEIDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-893-1200
Mailing Address - Street 1:200 TRENTON RD
Mailing Address - Street 2:
Mailing Address - City:BROWNS MILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:08015-1705
Mailing Address - Country:US
Mailing Address - Phone:609-893-1200
Mailing Address - Fax:609-735-0175
Practice Address - Street 1:200 TRENTON RD
Practice Address - Street 2:
Practice Address - City:BROWNS MILLS
Practice Address - State:NJ
Practice Address - Zip Code:08015-1705
Practice Address - Country:US
Practice Address - Phone:609-893-1200
Practice Address - Fax:609-735-0175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
076775Medicare ID - Type Unspecified