Provider Demographics
NPI:1477690527
Name:ST. MARY CARDIOLOGY ASSOCIATES
Entity type:Organization
Organization Name:ST. MARY CARDIOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAGADISH
Authorized Official - Middle Name:
Authorized Official - Last Name:DAMLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-840-1160
Mailing Address - Street 1:PO BOX 2140
Mailing Address - Street 2:
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-6140
Mailing Address - Country:US
Mailing Address - Phone:201-840-1160
Mailing Address - Fax:201-840-1170
Practice Address - Street 1:308 WILLOW AVE
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-3808
Practice Address - Country:US
Practice Address - Phone:201-840-1160
Practice Address - Fax:201-840-1170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJCC0223OtherPALMETTO RAILROAD MEDICAR
NJ3414302Medicaid
NJCC0223OtherPALMETTO RAILROAD MEDICAR
NJ605041Medicare PIN