Provider Demographics
NPI:1720144264
Name:CROSS COUNTY CARDIOLOGY
Entity Type:Organization
Organization Name:CROSS COUNTY CARDIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:PUMILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-941-8100
Mailing Address - Street 1:103 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1016
Mailing Address - Country:US
Mailing Address - Phone:201-941-8100
Mailing Address - Fax:201-941-2899
Practice Address - Street 1:38 MEADOWLANDS PKWY
Practice Address - Street 2:
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-2925
Practice Address - Country:US
Practice Address - Phone:201-941-8752
Practice Address - Fax:201-866-1890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05187300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherTAX ID#