MEDICARE: GRAMERCY CARDIACDIAGNOSTIC SVCS 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	:	1902209174
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRAMERCY CARDIACDIAGNOSTIC SVCS P.C.

Provider Business Mailing Address
First Line	:	21116 UNION TPKE
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11364-3241
Country	:	US
Telephone Number	:	212-475-8066
Fax Number	:	212-475-4175

Provider Business Practice Location Address
First Line	:	21116 UNION TPKE
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11364-3241
Country	:	US
Telephone Number	:	212-475-8066
Fax Number	:	212-475-4175

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

Provider Enumeration Date	:	10/02/2014
Last Update Date	:	10/02/2014

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