Provider Demographics
NPI:1023114931
Name:CARDIOTHORACIC SURGICAL GROUP OF NEW JERSEY
Entity type:Organization
Organization Name:CARDIOTHORACIC SURGICAL GROUP OF NEW JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLODZIEJ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-599-5320
Mailing Address - Street 1:601 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08629-1915
Mailing Address - Country:US
Mailing Address - Phone:609-599-5308
Mailing Address - Fax:609-599-5701
Practice Address - Street 1:601 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08629-1915
Practice Address - Country:US
Practice Address - Phone:609-599-5308
Practice Address - Fax:609-599-5701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0663352000OtherKEYSTONE HEALTHPLAN
NJ8308209Medicaid
CH1667OtherRR MEDICARE
NJ0663352000OtherAMERIHEALTH
748336OtherINDEPENDENT BCBS
NJ1150577OtherHORIZON NJ HEALTH
NJ8308209Medicaid