Healthcare Provider Details

I. General information

NPI: 1124147657
Provider Name (Legal Business Name): CLINICAL & INVASIVE CARDIOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 NEWARK AVE SUITE 300
BELLEVILLE NJ
07109-4119
US

IV. Provider business mailing address

36 NEWARK AVE SUITE 300
BELLEVILLE NJ
07109-4119
US

V. Phone/Fax

Practice location:
  • Phone: 973-751-7322
  • Fax: 973-759-3702
Mailing address:
  • Phone: 973-751-7322
  • Fax: 973-759-3702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberMA37311
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NN06775800
License Number StateNJ

VIII. Authorized Official

Name: DR. JAMES A QUINN IX
Title or Position: PRESIDENT
Credential: MD
Phone: 973-751-7322