Healthcare Provider Details

I. General information

NPI: 1982933271
Provider Name (Legal Business Name): HEART MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2009
Last Update Date: 02/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 N GILBERT ST BUILDING 3 SUITE 3-102
TINTON FALLS NJ
07701-4955
US

IV. Provider business mailing address

55 N GILBERT ST BUILDING 3 SUITE 3-102
TINTON FALLS NJ
07701-4955
US

V. Phone/Fax

Practice location:
  • Phone: 732-389-0266
  • Fax: 732-933-4100
Mailing address:
  • Phone: 732-389-0266
  • Fax: 732-933-4100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA05258900
License Number StateNJ

VIII. Authorized Official

Name: DR. JOHN S CLEMENTE
Title or Position: PRESIDENT
Credential: M.D
Phone: 732-414-8647