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General NPI Number Information
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NPI Number | 1609892090
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Entity Type | Organization
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Legal Business Name | JERSEY HEART CENTER, LLC
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 11/02/2009
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Provider Practice Location Address
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Address Line | 616 AMBOY AVE
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City | WOODBRIDGE
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State | NJ
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Zip | 07095-3164
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Country | US
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Telephone | 732-636-6262
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Fax | 732-636-8313
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Provider Business Mailing Address
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Address Line | 616 AMBOY AVE
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City | WOODBRIDGE
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State | NJ
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Zip | 07095-3164
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Country | US
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Telephone | 732-636-6262
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Fax | 732-636-8313
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. MAHMOOD ALAM
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Credential |
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Telephone | 732-636-6262
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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 | MA057458
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License Number State | NJ
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