Provider Demographics
NPI:1982636114
Name:NORTH JERSEY HEART,, PA
Entity Type:Organization
Organization Name:NORTH JERSEY HEART,, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARDIOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:EBRAHIM
Authorized Official - Middle Name:S
Authorized Official - Last Name:ISSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-907-0995
Mailing Address - Street 1:800 GRANGE RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4420
Mailing Address - Country:US
Mailing Address - Phone:201-907-0995
Mailing Address - Fax:201-907-0996
Practice Address - Street 1:800 GRANGE RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4420
Practice Address - Country:US
Practice Address - Phone:201-907-0995
Practice Address - Fax:201-907-0996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07180900174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8536708Medicaid
NJE62920Medicare UPIN
NJ046266SNJMedicare ID - Type Unspecified