Provider Demographics
NPI:1669778791
Name:CARDIOMED
Entity type:Organization
Organization Name:CARDIOMED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:HISHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HAJJAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-595-6444
Mailing Address - Street 1:1300 MAIN AVE
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-2266
Mailing Address - Country:US
Mailing Address - Phone:973-595-6444
Mailing Address - Fax:973-782-4819
Practice Address - Street 1:1300 MAIN AVE
Practice Address - Street 2:SUITE D
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2266
Practice Address - Country:US
Practice Address - Phone:973-595-6444
Practice Address - Fax:973-782-4819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05702400174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty