Healthcare Provider Details

I. General information

NPI: 1770619264
Provider Name (Legal Business Name): CARDIAC ARRHYTHMIA SPECIALIST PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 10/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 CLIFTON AVE
CLIFTON NJ
07011-3259
US

IV. Provider business mailing address

54 FOREST HILLS WAY
CEDAR GROVE NJ
07009-2031
US

V. Phone/Fax

Practice location:
  • Phone: 201-791-6900
  • Fax: 201-794-1167
Mailing address:
  • Phone: 201-791-6900
  • Fax: 201-794-1167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberMA62803
License Number StateNJ

VIII. Authorized Official

Name: ATUL PRAKASH
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 201-791-6900