Healthcare Provider Details

I. General information

NPI: 1053375600
Provider Name (Legal Business Name): THE CARDIOLOGY GROUP, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 BRIGGS RD
MOUNT LAUREL NJ
08054-4608
US

IV. Provider business mailing address

2051 BRIGGS RD
MOUNT LAUREL NJ
08054-4608
US

V. Phone/Fax

Practice location:
  • Phone: 856-581-2127
  • Fax: 856-273-9346
Mailing address:
  • Phone: 856-581-2127
  • Fax: 856-273-9346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. JAMES O'BRIEN
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 856-581-2127