Provider Demographics
NPI:1669068128
Name:MGH CARDIOVASCULAR ASSOCIATES LLC
Entity type:Organization
Organization Name:MGH CARDIOVASCULAR ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIRETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:HABIB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-653-5867
Mailing Address - Street 1:680 BROADWAY STE 503
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07514-1530
Mailing Address - Country:US
Mailing Address - Phone:973-653-5867
Mailing Address - Fax:
Practice Address - Street 1:680 BROADWAY STE 503
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07514-1530
Practice Address - Country:US
Practice Address - Phone:973-653-5867
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MGH CARDIOVASCULAR ASSOCIATES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty