Healthcare Provider Details

I. General information

NPI: 1427050806
Provider Name (Legal Business Name): CARDIOVASCULAR GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BARTOL AVE STE 10
RIDLEY PARK PA
19078-2214
US

IV. Provider business mailing address

1 BARTOL AVE STE 10
RIDLEY PARK PA
19078-2214
US

V. Phone/Fax

Practice location:
  • Phone: 610-521-0150
  • Fax: 610-521-0567
Mailing address:
  • Phone: 610-521-0150
  • Fax: 610-521-0567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL R RUBY
Title or Position: PRESIDENT
Credential: MD
Phone: 610-521-0150