Healthcare Provider Details

I. General information

NPI: 1629133491
Provider Name (Legal Business Name): HEART FAILURE SPECIALISTS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 03/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROSPECT AVE SUITE 201
HACKENSACK NJ
07601-1997
US

IV. Provider business mailing address

20 PROSPECT AVE SUITE 201
HACKENSACK NJ
07601-1997
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-4849
  • Fax: 551-996-5703
Mailing address:
  • Phone: 551-996-4849
  • Fax: 551-996-5703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MA05291700
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0868604
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name: DR. ROBERT L BERKOWITZ
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 201-996-4849