1194016618 NPI number — GRAMERCY CARDIAC DIAGNOSTIC SERVICES, 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 1194016618 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:
1194016618
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
920 BROADWAY
Provider Second Line Business Mailing Address:
SUITE 600
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10010-6004
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:
2329 NOSTRAND AVE
Provider Second Line Business Practice Location Address:
600
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11210-3839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-859-0046
Provider Business Practice Location Address Fax Number:
718-859-0105
Provider Enumeration Date:
05/02/2011

Additional Information

Authorized Official

Authorized Official Last Name:
LABARBERA
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINSTRATOR
Authorized Official Telephone Number:
212-475-8066

Provider Taxonomy Codes

  • Taxonomy code: 207UN0901X , with the licence number:  144465 , 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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