Provider Demographics
NPI:1306994827
Name:NORTH JERSEY THORACIC SURGICAL ASSOCIATES, PC
Entity type:Organization
Organization Name:NORTH JERSEY THORACIC SURGICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:WIDMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-644-4844
Mailing Address - Street 1:PO BOX 1348
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07962-1348
Mailing Address - Country:US
Mailing Address - Phone:973-644-4844
Mailing Address - Fax:973-644-4776
Practice Address - Street 1:100 MADISON AVE FL 4
Practice Address - Street 2:CAROL G. SIMON CANCER CENTER SUITE 4101
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6136
Practice Address - Country:US
Practice Address - Phone:973-644-4844
Practice Address - Fax:973-644-4776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7916122OtherAETNA GROUP ID