Healthcare Provider Details

I. General information

NPI: 1700010741
Provider Name (Legal Business Name): CARDIOVASCULAR IMAGING SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2009
Last Update Date: 05/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

763 CONVERY BLVD ROUTE 35 SOUTH SUITE L1
PERTH AMBOY NJ
08861-2525
US

IV. Provider business mailing address

763 CONVERY BLVD ROUTE 35 SOUTH SUITE L1
PERTH AMBOY NJ
08861-2525
US

V. Phone/Fax

Practice location:
  • Phone: 732-331-3400
  • Fax:
Mailing address:
  • Phone: 732-331-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number
License Number State

VIII. Authorized Official

Name: JESUS M CARABALLO
Title or Position: CARDIOVASCULAR TECHNOLOGIST
Credential:
Phone: 732-331-3400