Provider Demographics
NPI:1720080203
Name:SOUTH JERSEY CARDIOLOGY, P.C.
Entity Type:Organization
Organization Name:SOUTH JERSEY CARDIOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:SHAPIRO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:856-293-7466
Mailing Address - Street 1:1203 N HIGH ST
Mailing Address - Street 2:UNIT B
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332-2530
Mailing Address - Country:US
Mailing Address - Phone:856-293-7466
Mailing Address - Fax:856-293-7472
Practice Address - Street 1:1203 N HIGH ST
Practice Address - Street 2:UNIT B
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332-2530
Practice Address - Country:US
Practice Address - Phone:856-293-7466
Practice Address - Fax:856-293-7472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-14
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE2378OtherRRMCR
NJ7600801Medicaid
054614Medicare PIN