Provider Demographics
NPI:1114081494
Name:GARDEN STATE CARDIOLOGY ASSOCIATES P.C.
Entity type:Organization
Organization Name:GARDEN STATE CARDIOLOGY ASSOCIATES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:RAJENDRA
Authorized Official - Middle Name:B
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MDFACC
Authorized Official - Phone:856-782-9200
Mailing Address - Street 1:707 WHITE HORSE RD
Mailing Address - Street 2:C 104
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-2461
Mailing Address - Country:US
Mailing Address - Phone:856-782-9200
Mailing Address - Fax:856-782-9292
Practice Address - Street 1:707 WHITE HORSE RD
Practice Address - Street 2:C 104
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-2461
Practice Address - Country:US
Practice Address - Phone:856-782-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA60281246W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246W00000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6147607Medicaid
NJF25758Medicare UPIN
NJ747762Medicare ID - Type Unspecified