MEDICARE: GRAMERCY CARDIAC DIAGNOSTIC SERVICES, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207UN0901X	Nuclear Cardiology Physician	144465	NY

General Provider Information

NPI Number	:	1194016618
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRAMERCY CARDIAC DIAGNOSTIC SERVICES, P.C.

Provider Business Mailing Address
First Line	:	920 BROADWAY
Second Line	:	SUITE 600
City	:	NEW YORK
State	:	NY
Zip	:	10010-6004
Country	:	US
Telephone Number	:	212-475-8066
Fax Number	:	212-475-4175

Provider Business Practice Location Address
First Line	:	2329 NOSTRAND AVE
Second Line	:	600
City	:	BROOKLYN
State	:	NY
Zip	:	11210-3839
Country	:	US
Telephone Number	:	718-859-0046
Fax Number	:	718-859-0105

Authorized Official
Title or Position	:	ADMINSTRATOR
Name	:	MR. BRIAN LABARBERA
Credential	:
Telephone Number	:	212-475-8066

Provider Enumeration Date	:	05/02/2011
Last Update Date	:	08/19/2014

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