Healthcare Provider Details

I. General information

NPI: 1093993032
Provider Name (Legal Business Name): SBMC STRESS TEST PANEL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2008
Last Update Date: 02/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 OLD SHORT HILLS RD
LIVINGSTON NJ
07039-5672
US

IV. Provider business mailing address

PO BOX 8500 LOCKBOX #8066
PHILADELPHIA PA
19178-8500
US

V. Phone/Fax

Practice location:
  • Phone: 973-322-8892
  • Fax: 973-422-0838
Mailing address:
  • Phone: 866-295-0041
  • Fax: 732-557-7109

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: MR. PATRICK AHEARN
Title or Position: DIRECTOR
Credential:
Phone: 732-557-7119