MEDICARE: CLARABARTON CARDIO MEDICAL ASSOCIATION INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician
2	207RC0000X	Cardiovascular Disease Physician

General Provider Information

NPI Number	:	1215019997
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLARABARTON CARDIO MEDICAL ASSOCIATION INC.

Provider Business Mailing Address
First Line	:	565 NEW BRUNSWICK AVE
Second Line	:
City	:	FORDS
State	:	NJ
Zip	:	08863-2162
Country	:	US
Telephone Number	:	732-738-8000
Fax Number	:	732-738-1663

Provider Business Practice Location Address
First Line	:	565 NEW BRUNSWICK AVE
Second Line	:
City	:	FORDS
State	:	NJ
Zip	:	08863-2162
Country	:	US
Telephone Number	:	732-738-8000
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PERVAIZE LATIF
Credential	:	M.D.
Telephone Number	:	732-738-8000

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	10/01/2010

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