MEDICARE: CARDIOCARE PC

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	207RC0000X	Cardiovascular Disease Physician	223734	NY

General Provider Information

NPI Number	:	1457638702
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIOCARE PC

Provider Business Mailing Address
First Line	:	777 ADDISON ST
Second Line	:
City	:	WOODMERE
State	:	NY
Zip	:	11598-2937
Country	:	US
Telephone Number	:	718-440-6161
Fax Number	:

Provider Business Practice Location Address
First Line	:	128 BEACH 115TH ST
Second Line	:
City	:	ROCKAWAY PARK
State	:	NY
Zip	:	11694-2408
Country	:	US
Telephone Number	:	718-474-6400
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ZAZA AIVAZI
Credential	:	M.D.,
Telephone Number	:	718-440-6161

Provider Enumeration Date	:	11/14/2011
Last Update Date	:	11/14/2011

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Directions to “CARDIOCARE PC ” Practice Location

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