Basic Information
Provider Information
NPI: 1295972131
EntityType: 2
ReplacementNPI:  
OrganizationName: HEARTPATH CARDIOVASCULAR SERVICES, PLLC
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Mailing Information
Address1: 206 FALLWOOD PKWY
Address2:  
City: FARMINGDALE
State: NY
PostalCode: 117354929
CountryCode: US
TelephoneNumber: 5162491020
FaxNumber: 5162491305
Practice Location
Address1: 206 FALLWOOD PKWY
Address2:  
City: FARMINGDALE
State: NY
PostalCode: 117354929
CountryCode: US
TelephoneNumber: 5162491020
FaxNumber: 5162491305
Other Information
ProviderEnumerationDate: 01/14/2009
LastUpdateDate: 01/14/2009
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: TRAZZERA
AuthorizedOfficialFirstName: SALVATORE
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AuthorizedOfficialTitleorPosition: MEDICAL DIRECTOR
AuthorizedOfficialTelephone: 5162491020
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: M.D.
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0000X187894NYY193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease

No ID Information.


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