Healthcare Provider Details

I. General information

NPI: 1598959116
Provider Name (Legal Business Name): EAST COAST CARDIOLOGY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 10/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8075 GATE PKWY W STE 301
JACKSONVILLE FL
32216-3685
US

IV. Provider business mailing address

8075 GATE PKWY W STE 301
JACKSONVILLE FL
32216-3685
US

V. Phone/Fax

Practice location:
  • Phone: 904-296-7775
  • Fax: 904-296-7760
Mailing address:
  • Phone: 904-296-7775
  • Fax: 904-296-7760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberME92691
License Number StateFL

VIII. Authorized Official

Name: ABDUL R KANI
Title or Position: PRESIDENT
Credential: MD
Phone: 904-296-7775