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General NPI Number Information
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NPI Number | 1316093719
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Entity Type | Organization
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Legal Business Name | GARDEN STATE CARDIOLOGY
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 08/22/2008
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Provider Practice Location Address
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Address Line | 1124 E RIDGEWOOD AVE SUITE 202
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-3915
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Country | US
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Telephone | 201-689-0091
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Fax | 201-689-9404
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Provider Business Mailing Address
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Address Line | 1 W RIDGEWOOD AVE SUITE 103
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City | PARAMUS
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State | NJ
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Zip | 07652-2359
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Country | US
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Telephone | 201-689-0091
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Fax | 201-689-9404
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Authorized Official
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Title or Position | BILLING
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Name | DONNA DWYER
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Credential |
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Telephone | 201-689-0091
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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 | MA04851100
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License Number State | NJ
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