Basic Information
| Provider Information | |||||||||
| NPI: | 1043387079 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEW ROCHELLE CARDIOLOGY ASSOC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 150 LOCKWOOD AVE RM 28 | ||||||||
| Address2: | |||||||||
| City: | NEW ROCHELLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146333914 | ||||||||
| FaxNumber: | 9146337626 | ||||||||
| Practice Location | |||||||||
| Address1: | 150 LOCKWOOD AVE RM 28 | ||||||||
| Address2: | |||||||||
| City: | NEW ROCHELLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146333914 | ||||||||
| FaxNumber: | 9146333914 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | KAPLAN | ||||||||
| AuthorizedOfficialFirstName: | JANET | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9146336334 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 00876742 | 05 | NY | MEDICAID |