Healthcare Provider Details

I. General information

NPI: 1790977056
Provider Name (Legal Business Name): NEW JERSEY ELECTROPHYSIOLOGY ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2007
Last Update Date: 04/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 LYONS AVE
NEWARK NJ
07112
US

IV. Provider business mailing address

201 LYONS AVE
NEWARK NJ
07112
US

V. Phone/Fax

Practice location:
  • Phone: 973-926-8590
  • Fax: 973-926-6758
Mailing address:
  • Phone: 973-926-8590
  • Fax: 973-926-6758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberMA35123
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RI0001X
TaxonomyClinical & Laboratory Immunology (Internal Medicine) Physician
License NumberMA03512300
License Number StateNJ

VIII. Authorized Official

Name: STEPHEN TOBIAS ROTHBART
Title or Position: OWNER
Credential: MD
Phone: 973-926-8590