1649871260 NPI number — ADVANCED CARDIOVASCULAR DIAGNOSTICS, PLLC

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 1649871260 NPI number — ADVANCED CARDIOVASCULAR DIAGNOSTICS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED CARDIOVASCULAR DIAGNOSTICS, 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:
1649871260
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1129 NORTHERN BLVD STE 404
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANHASSET
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11030-3022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-774-4195
Provider Business Mailing Address Fax Number:
516-362-6252

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1129 NORTHERN BLVD STE 404
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANHASSET
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11030-3022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-774-4195
Provider Business Practice Location Address Fax Number:
516-362-6252
Provider Enumeration Date:
11/02/2020

Additional Information

Authorized Official

Authorized Official Last Name:
FRANKEL
Authorized Official First Name:
PERRY
Authorized Official Middle Name:
ARNOLD
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
516-488-5050

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: 01835363 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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