Healthcare Provider Details

I. General information

NPI: 1104003490
Provider Name (Legal Business Name): METROPOLITAN CARDIOVASCULAR CONSULTANTS,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 SUMMIT AVE STE 200
HACKENSACK NJ
07601-1271
US

IV. Provider business mailing address

PO BOX 67
HACKENSACK NJ
07602-0067
US

V. Phone/Fax

Practice location:
  • Phone: 201-264-4734
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA07271800
License Number StateNJ

VII. Legacy identifiers

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

VIII. Authorized Official

Name: GEORGE STOUPAKIS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 201-264-4734