MEDICARE: GARDEN STATE CARDIO PULMONARY DIAGNOS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BX2000X	Oxygen Equipment & Supplies (DME)	N/A IN NJ AND NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790891562
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARDEN STATE CARDIO PULMONARY DIAGNOS

Provider Business Mailing Address
First Line	:	135 FORT LEE RD
Second Line	:	SUITE # 201
City	:	LEONIA
State	:	NJ
Zip	:	07605-2247
Country	:	US
Telephone Number	:	201-592-0777
Fax Number	:	201-592-0078

Provider Business Practice Location Address
First Line	:	135 FORT LEE RD
Second Line	:	SUITE # 201
City	:	LEONIA
State	:	NJ
Zip	:	07605-2247
Country	:	US
Telephone Number	:	201-592-0777
Fax Number	:	201-592-0078

Authorized Official
Title or Position	:	OWNER PRESIDENT
Name	:	MR. KOSAR KAZMI
Credential	:	RT
Telephone Number	:	201-592-0777

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	08/22/2020

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