Healthcare Provider Details

I. General information

NPI: 1720080203
Provider Name (Legal Business Name): SOUTH JERSEY CARDIOLOGY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2005
Last Update Date: 12/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 N HIGH ST UNIT B
MILLVILLE NJ
08332-2530
US

IV. Provider business mailing address

1203 N HIGH ST UNIT B
MILLVILLE NJ
08332-2530
US

V. Phone/Fax

Practice location:
  • Phone: 856-293-7466
  • Fax: 856-293-7472
Mailing address:
  • Phone: 856-293-7466
  • Fax: 856-293-7472

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: DR. BARRY E SHAPIRO
Title or Position: PRESIDENT
Credential: D.O.
Phone: 856-293-7466