Provider Demographics
NPI:1861447096
Name:CARDIO MEDICAL GROUP, P.A.
Entity Type:Organization
Organization Name:CARDIO MEDICAL GROUP, P.A.
Other - Org Name:EDISON EMERGI MED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-635-1100
Mailing Address - Street 1:98 JAMES ST
Mailing Address - Street 2:SUITE 313
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3902
Mailing Address - Country:US
Mailing Address - Phone:732-635-0916
Mailing Address - Fax:732-494-4907
Practice Address - Street 1:98 JAMES ST
Practice Address - Street 2:SUITE 313
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3902
Practice Address - Country:US
Practice Address - Phone:732-635-0916
Practice Address - Fax:732-494-4907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25NO09381600163W00000X
NJ26NO12044400163W00000X
NJ25MA07096500207R00000X
NJ25MA08472200207R00000X
NJ25MA04440500207RC0000X
NJ25MA04122700207RC0000X
NJ25NN09381600363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3397700Medicaid
NJ3397700Medicaid