Provider Demographics
NPI:1396762050
Name:MAINLAND HEART CONSULTANTS
Entity type:Organization
Organization Name:MAINLAND HEART CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:E
Authorized Official - Last Name:GANSERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-404-9900
Mailing Address - Street 1:318 CHRIS GAUPP DR
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-4460
Mailing Address - Country:US
Mailing Address - Phone:609-404-9900
Mailing Address - Fax:609-404-3653
Practice Address - Street 1:318 CHRIS GAUPP DR
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-4460
Practice Address - Country:US
Practice Address - Phone:609-404-9900
Practice Address - Fax:609-404-3653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ605324OtherAETNA
NJG537870OtherOXFORD
NJ0364554000OtherAMERIHEALTH
NJG537870OtherOXFORD
NJMA720925Medicare PIN