Basic Information
| Provider Information | |||||||||
| NPI: | 1629264353 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GANDELMAN CARDIOLOGY, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 67 HOLLY HILL LN | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | GREENWICH | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068306072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2038695515 | ||||||||
| FaxNumber: | 2038695765 | ||||||||
| Practice Location | |||||||||
| Address1: | 67 HOLLY HILL LN | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | GREENWICH | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068306072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2038695515 | ||||||||
| FaxNumber: | 2038695765 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2007 | ||||||||
| LastUpdateDate: | 05/24/2020 | ||||||||
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| AuthorizedOfficialLastName: | GANDELMAN | ||||||||
| AuthorizedOfficialFirstName: | GLENN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2038695515 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 05/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 044021 | CT | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.