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General NPI Number Information
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NPI Number | 1306994827
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Entity Type | Organization
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Legal Business Name | NORTH JERSEY THORACIC SURGICAL ASSOCIATES, PC
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 03/13/2013
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Provider Practice Location Address
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Address Line | 100 MADISON AVE FL 4 CAROL G. SIMON CANCER CENTER SUITE 4101
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City | MORRISTOWN
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State | NJ
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Zip | 07960-6136
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Country | US
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Telephone | 973-644-4844
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Fax | 973-644-4776
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Provider Business Mailing Address
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Address Line | PO BOX 1348
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City | MORRISTOWN
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State | NJ
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Zip | 07962-1348
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Country | US
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Telephone | 973-644-4844
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Fax | 973-644-4776
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK D WIDMANN
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Credential | MD
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Telephone | 973-644-4844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number |
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License Number State |
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