Organization Active NPI

Cardiovascular Associates of Hudson County PA

  • Preferred Provider Organization
  • Jersey City, NJ
National Provider Identifier
1336363258
Registry record updated Nov 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preferred Provider OrganizationTaxonomy code 305R00000X
License
MA72103 Issued in NJ
Legal business name
CARDIOVASCULAR ASSOCIATES OF HUDSON COUNTY PA
Practice address
377 Jersey Ave Ste 410
Jersey City, NJ 07302-4397
Phone
(201) 200-0318
Fax
(201) 200-0319
NPI assigned
Apr 12, 2007
Last updated
Nov 6, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jacqueline M Mayes
Title
Director
Phone
(201) 200-0318

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Preferred Provider Organization 305R00000X MA69555 NJ
Preferred Provider Organization 305R00000X MA72103 NJ Primary

Addresses

Primary practice location

377 Jersey Ave Ste 410
Jersey City, NJ 07302-4397

Mailing address

PO Box 446
Jersey City, NJ 07303-0446
Phone (201) 200-0318

Other practice location 1

1931 Oak Tree Rd Ste 202
Edison, NJ 08820-2072
Phone (732) 372-7633

Other identifiers 1

IdentifierTypeStateIssuer
8973806MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040202001084 NJ Part B Supplier - Clinic/Group Practice 8224921531 Receives reassigned benefits from 3 practitioners
Practice locations: Edison, NJ; Jersey City, NJ

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
31D2025516Cardiovascular Associates of Hudson County PA377 Jersey City Ave Suite 410, Jersey City, NJ 07302Certificate of waiverMay 4, 2028

National Provider Directory

National Provider Directory

Locations

3900 Park Ave
Ste 104
Edison, NJ 08820
Phone (732) 452-0057

377 Jersey Ave
Ste 410
Jersey City, NJ 07302
Phone (201) 200-0318

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604620800000",
    "number": "1336363258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 446",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073030446",
            "telephone_number": "201-200-0318",
            "fax_number": "201-200-0319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "377 JERSEY AVE STE 410",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073024397",
            "telephone_number": "201-200-0318",
            "fax_number": "201-200-0319"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1931 Oak Tree Rd Ste 202",
            "address_purpose": "LOCATION",
            "city": "Edison",
            "state": "NJ",
            "postal_code": "088202072",
            "country_code": "US",
            "telephone_number": "732-372-7633",
            "fax_number": "732-372-7634",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CARDIOVASCULAR ASSOCIATES OF HUDSON COUNTY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-12",
        "last_updated": "2020-11-06",
        "certification_date": "2020-11-06",
        "status": "A",
        "authorized_official_last_name": "MAYES",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "201-200-0318"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "NJ",
            "license": "MA69555",
            "primary": false
        },
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "NJ",
            "license": "MA72103",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8973806",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jersey City, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.