MEDICARE: CARDIOVASCULAR IMAGING 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	259363-1	NY

General Provider Information

NPI Number	:	1841602323
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIOVASCULAR IMAGING PC

Provider Business Mailing Address
First Line	:	3520 90TH ST
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-5855
Country	:	US
Telephone Number	:	718-267-0510
Fax Number	:	718-267-8196

Provider Business Practice Location Address
First Line	:	3520 90TH ST
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-5855
Country	:	US
Telephone Number	:	718-267-0510
Fax Number	:	718-267-8196

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TAREK MOHAMED MOUSA
Credential	:	M.D
Telephone Number	:	718-267-0510

Provider Enumeration Date	:	06/02/2014
Last Update Date	:	06/02/2014

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