Healthcare Provider Details

I. General information

NPI: 1043432529
Provider Name (Legal Business Name): CARDIOTHORACIC ANESTHESIA GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 NORTH VAN DIEN AVENUE
RIDGEWOOD NJ
07450
US

IV. Provider business mailing address

P.O. BOX 629
FRANKLIN LAKES NJ
07417
US

V. Phone/Fax

Practice location:
  • Phone: 201-447-8000
  • Fax:
Mailing address:
  • Phone: 201-847-9403
  • Fax: 201-847-0059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNJ

VIII. Authorized Official

Name: MR. BRIAN COLE
Title or Position: OFFICE MANAGER
Credential:
Phone: 201-847-9320