1013044551 NPI number — CONCOURSE CARDIOLOGY ASSOCIATES, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013044551 NPI number — CONCOURSE CARDIOLOGY ASSOCIATES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONCOURSE CARDIOLOGY ASSOCIATES, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013044551
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16 FAWN LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARMONK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10504-1126
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3130 GRAND CONCOURSE
Provider Second Line Business Practice Location Address:
SUITE 1G
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10458-1213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-733-5299
Provider Business Practice Location Address Fax Number:
718-733-2873
Provider Enumeration Date:
02/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GUPTA
Authorized Official First Name:
VEENA
Authorized Official Middle Name:
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
718-733-5299

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  163921 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 011823922 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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