1104243633 NPI number — CARDIOVASCULAR SERVICES OF DR TAREK MOUSA 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 1104243633 NPI number — CARDIOVASCULAR SERVICES OF DR TAREK MOUSA PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARDIOVASCULAR SERVICES OF DR TAREK MOUSA 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:
1104243633
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2427 STEINWAY STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASTORIA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
929-208-0080
Provider Business Mailing Address Fax Number:
929-208-0010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2427 STEINWAY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASTORIA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11103-3654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
929-208-0080
Provider Business Practice Location Address Fax Number:
929-208-0010
Provider Enumeration Date:
03/21/2014

Additional Information

Authorized Official

Authorized Official Last Name:
MOUSA
Authorized Official First Name:
TAREK
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
347-556-7769

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  259363 , 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)





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