Provider Demographics
NPI:1770619264
Name:CARDIAC ARRHYTHMIA SPECIALIST PC
Entity type:Organization
Organization Name:CARDIAC ARRHYTHMIA SPECIALIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ATUL
Authorized Official - Middle Name:
Authorized Official - Last Name:PRAKASH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-791-6900
Mailing Address - Street 1:54 FOREST HILLS WAY
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-2031
Mailing Address - Country:US
Mailing Address - Phone:201-791-6900
Mailing Address - Fax:201-794-1167
Practice Address - Street 1:524 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-3259
Practice Address - Country:US
Practice Address - Phone:201-791-6900
Practice Address - Fax:201-794-1167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA62803207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ892949Medicare ID - Type Unspecified