Provider Demographics
NPI:1336363258
Name:CARDIOVASCULAR ASSOCIATES OF HUDSON COUNTY PA
Entity Type:Organization
Organization Name:CARDIOVASCULAR ASSOCIATES OF HUDSON COUNTY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-200-0318
Mailing Address - Street 1:PO BOX 446
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07303-0446
Mailing Address - Country:US
Mailing Address - Phone:201-200-0318
Mailing Address - Fax:201-200-0319
Practice Address - Street 1:377 JERSEY AVE STE 410
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-4397
Practice Address - Country:US
Practice Address - Phone:201-200-0318
Practice Address - Fax:201-200-0319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA72103305R00000X
NJMA69555305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8973806Medicaid
NJ8973806Medicaid
NJH38822Medicare UPIN
NJH04505Medicare UPIN