Basic Information
| Provider Information | |||||||||
| NPI: | 1649596610 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MOBILE CARDIO VASCULAR INC., | ||||||||
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| Mailing Information | |||||||||
| Address1: | 171 SCENIC RD | ||||||||
| Address2: | |||||||||
| City: | MOHEGAN LAKE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105471254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9143748731 | ||||||||
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| Practice Location | |||||||||
| Address1: | 540 ATLANTIC AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112171985 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185452100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2010 | ||||||||
| LastUpdateDate: | 04/21/2010 | ||||||||
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| AuthorizedOfficialLastName: | WILSON | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9143748731 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 335V00000X | Y | Suppliers | Portable X-Ray Supplier |
No ID Information.