Provider Demographics
NPI:1871721498
Name:AHA MEDICAL PC
Entity type:Organization
Organization Name:AHA MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:AVELLINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-381-3108
Mailing Address - Street 1:364 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:KEYPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:07735-1619
Mailing Address - Country:US
Mailing Address - Phone:800-381-3108
Mailing Address - Fax:800-322-0262
Practice Address - Street 1:364 BROAD ST
Practice Address - Street 2:
Practice Address - City:KEYPORT
Practice Address - State:NJ
Practice Address - Zip Code:07735-1619
Practice Address - Country:US
Practice Address - Phone:800-381-3108
Practice Address - Fax:800-322-0262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ148049246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty