Healthcare Provider Details

I. General information

NPI: 1295988616
Provider Name (Legal Business Name): CARDIOVASCULAR ASSOCIATES, P.A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2008
Last Update Date: 12/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10-14 SADDLE RIVER RD
FAIR LAWN NJ
07410-5728
US

IV. Provider business mailing address

10-14 SADDLE RIVER RD
FAIR LAWN NJ
07410-5728
US

V. Phone/Fax

Practice location:
  • Phone: 201-794-3256
  • Fax: 201-794-6457
Mailing address:
  • Phone: 201-794-3256
  • Fax: 201-794-6457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number024765
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number024765
License Number StateNJ

VIII. Authorized Official

Name: DR. MAHMUD BANGASH
Title or Position: PRESIDENT
Credential: M,D,
Phone: 201-794-3256