Provider Demographics
NPI:1770513517
Name:CARDIAC CARE SPECIALISTS P.C.
Entity type:Organization
Organization Name:CARDIAC CARE SPECIALISTS P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:JUDD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-374-5167
Mailing Address - Street 1:1020 LAUREL OAK RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-3518
Mailing Address - Country:US
Mailing Address - Phone:856-374-5167
Mailing Address - Fax:856-374-5168
Practice Address - Street 1:1020 LAUREL OAK RD
Practice Address - Street 2:SUITE 102
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-3518
Practice Address - Country:US
Practice Address - Phone:856-374-5167
Practice Address - Fax:856-374-5168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6286801Medicaid
NJ022531Medicare ID - Type UnspecifiedGROUP PROVIDER ID#