Basic Information
| Provider Information | |||||||||
| NPI: | 1639471725 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MERRICK NUCLEAR CARDIOLOG PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1703 MERRICK AVE | ||||||||
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| City: | MERRICK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115661628 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 1703 MERRICK AVE | ||||||||
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| City: | MERRICK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115661628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5163783311 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2010 | ||||||||
| LastUpdateDate: | 12/03/2010 | ||||||||
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| AuthorizedOfficialLastName: | GUPTA | ||||||||
| AuthorizedOfficialFirstName: | ARUN | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | MD | ||||||||
| AuthorizedOfficialTelephone: | 5163783311 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.