Basic Information
| Provider Information | |||||||||
| NPI: | 1063545689 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ENGLEWOOD CARDIAC SURGERY ASSOCIATES, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 350 ENGLE ST | ||||||||
| Address2: | SUITE 1000 | ||||||||
| City: | ENGLEWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076311808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2018943636 | ||||||||
| FaxNumber: | 2015412188 | ||||||||
| Practice Location | |||||||||
| Address1: | 350 ENGLE ST | ||||||||
| Address2: | SUITE 1000 | ||||||||
| City: | ENGLEWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076311808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2018943636 | ||||||||
| FaxNumber: | 2015412188 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2007 | ||||||||
| LastUpdateDate: | 10/13/2009 | ||||||||
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| AuthorizedOfficialLastName: | ERGIN | ||||||||
| AuthorizedOfficialFirstName: | M. | ||||||||
| AuthorizedOfficialMiddleName: | ARISAN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2018943636 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | MA70525 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 8239509 | 05 | NJ | MEDICAID |