Provider Demographics
NPI:1962698597
Name:CARDIOLOGY CENTER OF NEW JERSY LLC
Entity type:Organization
Organization Name:CARDIOLOGY CENTER OF NEW JERSY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:A
Authorized Official - Last Name:CRISCITO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-450-2158
Mailing Address - Street 1:32 CHELSEA DR
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-3420
Mailing Address - Country:US
Mailing Address - Phone:973-429-8363
Mailing Address - Fax:
Practice Address - Street 1:50 NEWARK AVE STE 204
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-1193
Practice Address - Country:US
Practice Address - Phone:973-450-2158
Practice Address - Fax:973-450-2027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02510600207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC58391Medicare UPIN
NJ118147Medicare PIN