Provider Demographics
NPI:1790891562
Name:GARDEN STATE CARDIO PULMONARY DIAGNOS
Entity type:Organization
Organization Name:GARDEN STATE CARDIO PULMONARY DIAGNOS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KOSAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KAZMI
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:201-592-0777
Mailing Address - Street 1:135 FORT LEE RD
Mailing Address - Street 2:SUITE # 201
Mailing Address - City:LEONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07605-2247
Mailing Address - Country:US
Mailing Address - Phone:201-592-0777
Mailing Address - Fax:201-592-0078
Practice Address - Street 1:135 FORT LEE RD
Practice Address - Street 2:SUITE # 201
Practice Address - City:LEONIA
Practice Address - State:NJ
Practice Address - Zip Code:07605-2247
Practice Address - Country:US
Practice Address - Phone:201-592-0777
Practice Address - Fax:201-592-0078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
N/A IN NJ AND NY332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01994710Medicaid
NJ7942605Medicaid
NJ7942605Medicaid