Healthcare Provider Details

I. General information

NPI: 1679967764
Provider Name (Legal Business Name): CARDIAC CARE ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254B MOUNTAIN AVE STE 203
HACKETTSTOWN NJ
07840-2413
US

IV. Provider business mailing address

254B MOUNTAIN AVE STE 203
HACKETTSTOWN NJ
07840-2413
US

V. Phone/Fax

Practice location:
  • Phone: 908-452-5642
  • Fax: 908-452-5657
Mailing address:
  • Phone: 908-452-5642
  • Fax: 908-452-5657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA07069400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number25MA07069400
License Number StateNJ

VIII. Authorized Official

Name: DR. ANIRUDH KHANNA
Title or Position: OWNER
Credential: M.D.
Phone: 908-452-5642