Basic Information
| Provider Information | |||||||||
| NPI: | 1457638702 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARDIOCARE PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 777 ADDISON ST | ||||||||
| Address2: | |||||||||
| City: | WOODMERE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115982937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184406161 | ||||||||
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| Practice Location | |||||||||
| Address1: | 128 BEACH 115TH ST | ||||||||
| Address2: | |||||||||
| City: | ROCKAWAY PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 116942408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184746400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2011 | ||||||||
| LastUpdateDate: | 11/14/2011 | ||||||||
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| AuthorizedOfficialLastName: | AIVAZI | ||||||||
| AuthorizedOfficialFirstName: | ZAZA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7184406161 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D., | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 223734 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.