Healthcare Provider Details

I. General information

NPI: 1720144264
Provider Name (Legal Business Name): CROSS COUNTY CARDIOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 MEADOWLANDS PKWY
SECAUCUS NJ
07094-2925
US

IV. Provider business mailing address

103 RIVER RD
EDGEWATER NJ
07020-1016
US

V. Phone/Fax

Practice location:
  • Phone: 201-941-8752
  • Fax: 201-866-1890
Mailing address:
  • Phone: 201-941-8100
  • Fax: 201-941-2899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MA05187300
License Number StateNJ

VIII. Authorized Official

Name: RICK PUMILL
Title or Position: DELEGATED OFFICIAL
Credential: M.D.
Phone: 201-941-8100