Healthcare Provider Details

I. General information

NPI: 1063545689
Provider Name (Legal Business Name): ENGLEWOOD CARDIAC SURGERY ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 10/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 ENGLE ST SUITE 1000
ENGLEWOOD NJ
07631-1808
US

IV. Provider business mailing address

350 ENGLE ST SUITE 1000
ENGLEWOOD NJ
07631-1808
US

V. Phone/Fax

Practice location:
  • Phone: 201-894-3636
  • Fax: 201-541-2188
Mailing address:
  • Phone: 201-894-3636
  • Fax: 201-541-2188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberMA70525
License Number StateNJ

VIII. Authorized Official

Name: DR. M. ARISAN ERGIN
Title or Position: PRESIDENT
Credential: MD
Phone: 201-894-3636