MEDICARE: CARDIAC ONE 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	:	1861768616
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIAC ONE LLC

Provider Business Mailing Address
First Line	:	15 SUNSHINE LN
Second Line	:
City	:	LIVINGSTON
State	:	NJ
Zip	:	07039-1128
Country	:	US
Telephone Number	:	973-533-1200
Fax Number	:	973-533-1222

Provider Business Practice Location Address
First Line	:	33 WOOD AVE S
Second Line	:	SUITE 600
City	:	ISELIN
State	:	NJ
Zip	:	08830-2735
Country	:	US
Telephone Number	:	973-533-1200
Fax Number	:	973-533-1222

Authorized Official
Title or Position	:	MANAGER
Name	:	SMITI M BHALODIA
Credential	:
Telephone Number	:	973-533-1200

Provider Enumeration Date	:	03/27/2012
Last Update Date	:	03/27/2012

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Directions to “CARDIAC ONE LLC ” Practice Location

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