Provider Demographics
NPI:1699889980
Name:HEART & VASCULAR ASSOCIATES OF NORTHERN JERSEY, P.A.
Entity type:Organization
Organization Name:HEART & VASCULAR ASSOCIATES OF NORTHERN JERSEY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:URGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-475-5050
Mailing Address - Street 1:22-18 BROADWAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-3016
Mailing Address - Country:US
Mailing Address - Phone:201-475-5050
Mailing Address - Fax:201-475-5522
Practice Address - Street 1:22-18 BROADWAY
Practice Address - Street 2:SUITE 201
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-3016
Practice Address - Country:US
Practice Address - Phone:201-475-5050
Practice Address - Fax:201-475-5522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8736502Medicaid
NJG48009Medicare UPIN
I51200Medicare UPIN
NJ052302Medicare PIN
NJF04030Medicare UPIN
NJD18882Medicare UPIN
D99021Medicare UPIN
NJF86333Medicare UPIN
NJ8736502Medicaid