Healthcare Provider Details

I. General information

NPI: 1922090786
Provider Name (Legal Business Name): SOUTH JERSEY HEART GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 10/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 CHAPEL AVE W SUITE 101
CHERRY HILL NJ
08002-1592
US

IV. Provider business mailing address

3001 CHAPEL AVE W SUITE 101
CHERRY HILL NJ
08002-1592
US

V. Phone/Fax

Practice location:
  • Phone: 856-482-8900
  • Fax: 856-482-7170
Mailing address:
  • Phone: 856-482-8900
  • Fax: 856-482-7170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMA46206
License Number StateNJ

VIII. Authorized Official

Name: SURENDRA K BAGARIA
Title or Position: CO-OWNER
Credential: MD
Phone: 856-589-0300