Healthcare Provider Details

I. General information

NPI: 1568342913
Provider Name (Legal Business Name): MYCARDIOVASCULAR CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2025
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

337 BLOOMFIELD AVE
NEWARK NJ
07107-2405
US

IV. Provider business mailing address

971 US HIGHWAY 202 N # 5135
BRANCHBURG NJ
08876-3757
US

V. Phone/Fax

Practice location:
  • Phone: 973-370-5259
  • Fax: 610-638-0771
Mailing address:
  • Phone: 973-370-5259
  • Fax: 610-638-0771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: SANKALP PATHAK
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 973-370-5259