Provider Demographics
NPI:1366495632
Name:CARDIOVASCULAR ASSOCIATES OF THE DELAWARE VALLEY,P A
Entity type:Organization
Organization Name:CARDIOVASCULAR ASSOCIATES OF THE DELAWARE VALLEY,P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-547-0539
Mailing Address - Street 1:120 WHITE HORSE PIKE
Mailing Address - Street 2:SUITE 112
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035-1927
Mailing Address - Country:US
Mailing Address - Phone:856-547-0539
Mailing Address - Fax:856-547-3178
Practice Address - Street 1:210 W ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:HADDON HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08035-1715
Practice Address - Country:US
Practice Address - Phone:856-547-0539
Practice Address - Fax:856-547-3178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6300006Medicaid
NJ6300006Medicaid
NJCA0993Medicare PIN