Provider Demographics
NPI:1861543811
Name:SUBURBAN HEART GROUP, PA
Entity type:Organization
Organization Name:SUBURBAN HEART GROUP, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:VITALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-964-7333
Mailing Address - Street 1:2333 MORRIS AVE
Mailing Address - Street 2:SUITE D-1
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-5714
Mailing Address - Country:US
Mailing Address - Phone:908-964-7333
Mailing Address - Fax:908-687-7855
Practice Address - Street 1:2333 MORRIS AVE
Practice Address - Street 2:SUITE D-1
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-5714
Practice Address - Country:US
Practice Address - Phone:908-964-7333
Practice Address - Fax:908-687-7855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5017106Medicaid
NJ405071Medicare ID - Type Unspecified