Healthcare Provider Details

I. General information

NPI: 1629391180
Provider Name (Legal Business Name): CARDIOLOGY AND VASCULAR CONSULTANTS OF NEW JERSEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2010
Last Update Date: 04/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2168 MILLBURN AVE SUITE 204
MAPLEWOOD NJ
07040-2640
US

IV. Provider business mailing address

2168 MILLBURN AVE SUITE 204
MAPLEWOOD NJ
07040-2640
US

V. Phone/Fax

Practice location:
  • Phone: 973-762-3353
  • Fax: 973-762-3370
Mailing address:
  • Phone: 800-243-5854
  • Fax: 206-824-9510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA08008500
License Number StateNJ

VIII. Authorized Official

Name: DR. KHALIL A KAID
Title or Position: OWNER
Credential: M.D
Phone: 347-581-0834