MEDICARE: CARDIOVASCULAR GROUP NJ LLC

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	207RC0000X	Cardiovascular Disease Physician

General Provider Information

NPI Number	:	1427362888
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIOVASCULAR GROUP NJ LLC

Provider Business Mailing Address
First Line	:	1 BARTOL AVE
Second Line	:	STE 10
City	:	RIDLEY PARK
State	:	PA
Zip	:	19078-2214
Country	:	US
Telephone Number	:	610-521-0150
Fax Number	:	610-521-6493

Provider Business Practice Location Address
First Line	:	230 LAUREL HEIGHTS DR
Second Line	:
City	:	BRIDGETON
State	:	NJ
Zip	:	08302-3634
Country	:	US
Telephone Number	:	610-521-0150
Fax Number	:	610-521-6493

Authorized Official
Title or Position	:	SENIOR PARTNER
Name	:	SAMUEL RUBY
Credential	:	MD
Telephone Number	:	610-521-0150

Provider Enumeration Date	:	07/27/2010
Last Update Date	:	07/27/2010

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