Basic Information
| Provider Information | |||||||||
| NPI: | 1053563759 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARDIOVASCULAR DIAGNOSTIC CARE OF NEW YORK P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 248 BAYVILLE AVE | ||||||||
| Address2: | P.O. BOX 1357 | ||||||||
| City: | BAYVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117091616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5167944161 | ||||||||
| FaxNumber: | 5167949568 | ||||||||
| Practice Location | |||||||||
| Address1: | 423 E 138TH ST | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104543041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182920100 | ||||||||
| FaxNumber: | 3475913862 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2008 | ||||||||
| LastUpdateDate: | 10/14/2008 | ||||||||
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| AuthorizedOfficialLastName: | RESTIVO | ||||||||
| AuthorizedOfficialFirstName: | PATTY | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 5167944161 | ||||||||
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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 | 174400000X | 1225121 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.