Healthcare Provider Details

I. General information

NPI: 1396762050
Provider Name (Legal Business Name): MAINLAND HEART CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 10/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 CHRIS GAUPP DR
GALLOWAY NJ
08205-4460
US

IV. Provider business mailing address

318 CHRIS GAUPP DR
GALLOWAY NJ
08205-4460
US

V. Phone/Fax

Practice location:
  • Phone: 609-404-9900
  • Fax: 609-404-3653
Mailing address:
  • Phone: 609-404-9900
  • Fax: 609-404-3653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENNIFER E GANSERT
Title or Position: ADMINSTRATOR
Credential:
Phone: 609-404-9900