Healthcare Provider Details

I. General information

NPI: 1780871285
Provider Name (Legal Business Name): IRPUS ELECTROPHYSIOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2007
Last Update Date: 09/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

946 BLOOMFIELD AVE
GLEN RIDGE NJ
07028-1304
US

IV. Provider business mailing address

946 BLOOMFIELD AVE
GLEN RIDGE NJ
07028-1304
US

V. Phone/Fax

Practice location:
  • Phone: 973-743-1121
  • Fax: 973-743-2627
Mailing address:
  • Phone: 973-743-1121
  • Fax: 973-743-2627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BART DE GREGORIO
Title or Position: SENIOR MEDICAL DIRECTOR
Credential: M.D.
Phone: 974-743-1121