1821065590 NPI number — NEW YORK CARDIOVASCULAR ASSOCIATES PLLC

Table of content: (NPI 1821065590)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821065590 NPI number — NEW YORK CARDIOVASCULAR ASSOCIATES PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW YORK CARDIOVASCULAR ASSOCIATES PLLC
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:
1821065590
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
275 7TH AVE
Provider Second Line Business Mailing Address:
3RD FLOOR
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-660-9999
Provider Business Mailing Address Fax Number:
646-778-3454

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
275 7TH AVE
Provider Second Line Business Practice Location Address:
3RD FLOOR
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-660-9999
Provider Business Practice Location Address Fax Number:
646-778-3450
Provider Enumeration Date:
03/02/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ELMQUIST
Authorized Official First Name:
PEG
Authorized Official Middle Name:
C
Authorized Official Title or Position:
CREDENTIALING OFFICER
Authorized Official Telephone Number:
646-778-3454

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RS0012X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207U00000X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 02654153 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".