Basic Information
| Provider Information | |||||||||
| NPI: | 1588277503 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCED HEART AND VASCULAR OF CENTRAL JERSEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1230 | ||||||||
| Address2: | |||||||||
| City: | EATONTOWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077245230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7323834200 | ||||||||
| FaxNumber: | 7327411895 | ||||||||
| Practice Location | |||||||||
| Address1: | 340 ROUTE 34 STE 201 | ||||||||
| Address2: | |||||||||
| City: | COLTS NECK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077222434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7324873636 | ||||||||
| FaxNumber: | 7324873635 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2020 | ||||||||
| LastUpdateDate: | 09/09/2020 | ||||||||
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| AuthorizedOfficialLastName: | FARRUGIA | ||||||||
| AuthorizedOfficialFirstName: | PETER | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 7325352765 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 09/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 0286087 | 05 | NJ | MEDICAID |