1336147859 NPI number — GRAMERCY CARDIAC DIAGNOSTIC SERVICES, P.C.

Table of content: (NPI 1336147859)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336147859 NPI number — GRAMERCY CARDIAC DIAGNOSTIC SERVICES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRAMERCY CARDIAC DIAGNOSTIC SERVICES, 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:
1336147859
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
131 W 35TH ST
Provider Second Line Business Mailing Address:
FLOOR 7
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10001-2111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-475-8066
Provider Business Mailing Address Fax Number:
212-475-4175

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
131 W 35TH ST
Provider Second Line Business Practice Location Address:
FLOOR 7
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10001-2111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-475-8066
Provider Business Practice Location Address Fax Number:
212-475-4175
Provider Enumeration Date:
07/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MARIN
Authorized Official First Name:
VICTORIA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRECERTIFICATION/CREDENTIALS
Authorized Official Telephone Number:
212-475-8066

Provider Taxonomy Codes

  • Taxonomy code: 207UN0901X , with the licence number:  60-144465-1 , 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: 7246 . This is a "AFFINITY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: NY00062 . This is a "BEECHSTREET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: WFL491 . This is a "EMPIRE BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00707915-011 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0607377 & 4547009 . This is a "AETNA HMO & PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 75979 . This is a "MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1701681 . This is a "FIRSTHEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0075979 . This is a "GHI PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 423458957 . This is a "HEALTHPLUS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P2616990 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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