Healthcare Provider Details

I. General information

NPI: 1588852016
Provider Name (Legal Business Name): CHANGE OF HEART CARDIOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2007
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 HIGHWAY 35 BLDG C STE 321
SEA GIRT NJ
08750-1010
US

IV. Provider business mailing address

2130 HIGHWAY 35 STE 325C
SEA GIRT NJ
08750-1010
US

V. Phone/Fax

Practice location:
  • Phone: 732-974-6700
  • Fax: 732-974-6707
Mailing address:
  • Phone: 732-774-2330
  • Fax: 732-774-1882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMB66061
License Number StateNJ

VIII. Authorized Official

Name: PETER HYNES
Title or Position: OWNER
Credential:
Phone: 732-974-6700