Basic Information
| Provider Information | |||||||||
| NPI: | 1649339011 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMPREHENSIVE CARDIAC CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 670 STONELEIGH AVE | ||||||||
| Address2: | STE 111 | ||||||||
| City: | CARMEL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105123997 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452793900 | ||||||||
| FaxNumber: | 8452794301 | ||||||||
| Practice Location | |||||||||
| Address1: | 670 STONELEIGH AVE | ||||||||
| Address2: | STE 111 | ||||||||
| City: | CARMEL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105123997 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452793900 | ||||||||
| FaxNumber: | 8452794301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BUTO | ||||||||
| AuthorizedOfficialFirstName: | KATHRYN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8452793900 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | RN,CPC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.