Provider Demographics
NPI:1013936202
Name:DOVER HEART SPECIALISTS, P.C.
Entity Type:Organization
Organization Name:DOVER HEART SPECIALISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:O
Authorized Official - Last Name:BACANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-557-4488
Mailing Address - Street 1:19 MULE RD STE C7
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-5061
Mailing Address - Country:US
Mailing Address - Phone:732-557-4488
Mailing Address - Fax:732-557-4617
Practice Address - Street 1:19 MULE RD STE C7
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-5061
Practice Address - Country:US
Practice Address - Phone:732-557-4488
Practice Address - Fax:732-557-4617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA04548600207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ068261Medicare ID - Type Unspecified