Provider Demographics
NPI:1982010468
Name:HEART HEALTH CENTER
Entity Type:Organization
Organization Name:HEART HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIREN
Authorized Official - Middle Name:
Authorized Official - Last Name:VANKAWALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-365-0730
Mailing Address - Street 1:427 E BROOK LN
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-2920
Mailing Address - Country:US
Mailing Address - Phone:609-365-0730
Mailing Address - Fax:609-423-1990
Practice Address - Street 1:54 W JIMMIE LEEDS RD
Practice Address - Street 2:SUITE # 14
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9438
Practice Address - Country:US
Practice Address - Phone:609-652-1868
Practice Address - Fax:609-423-1990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-07
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07979800261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ010770Medicaid
NJ010770Medicaid
NJG96062Medicare UPIN