Provider Demographics
NPI:1922090786
Name:SOUTH JERSEY HEART GROUP, PC
Entity Type:Organization
Organization Name:SOUTH JERSEY HEART GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SURENDRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:BAGARIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-589-0300
Mailing Address - Street 1:3001 CHAPEL AVE W
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-1592
Mailing Address - Country:US
Mailing Address - Phone:856-482-8900
Mailing Address - Fax:856-482-7170
Practice Address - Street 1:3001 CHAPEL AVE W
Practice Address - Street 2:SUITE 101
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-1592
Practice Address - Country:US
Practice Address - Phone:856-482-8900
Practice Address - Fax:856-482-7170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA46206207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ569007OtherAETNA
NJ7042507Medicaid
NJ569007OtherAETNA