Provider Demographics
NPI:1669697009
Name:GHCP EKG INTERPRETATION PANEL, LLC
Entity type:Organization
Organization Name:GHCP EKG INTERPRETATION PANEL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:CONROY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-444-5945
Mailing Address - Street 1:PO BOX 450
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07451-0450
Mailing Address - Country:US
Mailing Address - Phone:201-444-5945
Mailing Address - Fax:201-444-5947
Practice Address - Street 1:350 BOULEVARD
Practice Address - Street 2:ST. MARY'S HOSPITAL
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-2840
Practice Address - Country:US
Practice Address - Phone:201-444-5945
Practice Address - Fax:201-444-5947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ052636Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER