Basic Information
| Provider Information | |||||||||
| NPI: | 1295866077 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHELPS CARDIOVASCULAR PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2149 | ||||||||
| Address2: | |||||||||
| City: | DANBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068132149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037756659 | ||||||||
| FaxNumber: | 2037756692 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 N BROADWAY | ||||||||
| Address2: | |||||||||
| City: | SLEEPY HOLLOW | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105911020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9143663740 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | KAPLAN | ||||||||
| AuthorizedOfficialFirstName: | KENNETH | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9143663740 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 2084N0400X | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 01198190 | 05 | NY | MEDICAID |