Basic Information
| Provider Information | |||||||||
| NPI: | 1043432529 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARDIOTHORACIC ANESTHESIA GROUP, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 629 | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN LAKES | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2018479403 | ||||||||
| FaxNumber: | 2018470059 | ||||||||
| Practice Location | |||||||||
| Address1: | 223 NORTH VAN DIEN AVENUE | ||||||||
| Address2: | |||||||||
| City: | RIDGEWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2014478000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | COLE | ||||||||
| AuthorizedOfficialFirstName: | BRIAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2018479320 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | NJ | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.