Provider Demographics
NPI:1215974118
Name:CROSS COUNTY CARDIOLOGY P A
Entity type:Organization
Organization Name:CROSS COUNTY CARDIOLOGY P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
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:07020-1010
Mailing Address - Country:US
Mailing Address - Phone:201-941-8100
Mailing Address - Fax:
Practice Address - Street 1:103 RIVER RD
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-1010
Practice Address - Country:US
Practice Address - Phone:201-941-8100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05187300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0074887000OtherAMERIHEALTH GROUP#
NJ8079706Medicaid
NJCI3339OtherRAILROAD MEDICARE GROUP #
NJ0074887000OtherAMERIHEALTH GROUP#