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General NPI Number Information
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NPI Number | 1114066206
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Entity Type | Organization
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Legal Business Name | OLD PERTH CARDIOLOGY GROUP PA
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 08/10/2011
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Provider Practice Location Address
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Address Line | 280 AMBOY AVE
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City | METUCHEN
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State | NJ
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Zip | 08840-2426
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Country | US
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Telephone | 201-339-1700
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Fax | 201-339-6972
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Provider Business Mailing Address
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Address Line | PO BOX 79
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City | BAYONNE
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State | NJ
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Zip | 07002-0079
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Country | US
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Telephone | 201-339-1700
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Fax | 201-339-6972
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANTHONY CHIARAMIDA
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Credential | M.D.
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Telephone | 201-339-1700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MA05442900
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MA42221
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License Number State | NJ
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