1467422170 NPI number — RICHMOND CARDIOLOGICAL SERVICES, PC

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 1467422170 NPI number — RICHMOND CARDIOLOGICAL SERVICES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHMOND CARDIOLOGICAL SERVICES, PC
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:
1467422170
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
97 NEW DORP LN
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
STATEN ISLAND
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10306-2347
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-876-6220
Provider Business Mailing Address Fax Number:
718-876-5969

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
375 SEGUINE AVE
Provider Second Line Business Practice Location Address:
STATEN ISLAND UNIVERSITY HOSPITAL SOUTH, FLOOR 2
Provider Business Practice Location Address City Name:
STATEN ISLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10309-3932
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-226-2287
Provider Business Practice Location Address Fax Number:
718-226-2858
Provider Enumeration Date:
01/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LEFKOVIC
Authorized Official First Name:
LEONARD
Authorized Official Middle Name:
Authorized Official Title or Position:
C. E. O.
Authorized Official Telephone Number:
718-876-6220

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00780314 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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