Healthcare Provider Details

I. General information

NPI: 1053563759
Provider Name (Legal Business Name): CARDIOVASCULAR DIAGNOSTIC CARE OF NEW YORK P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2008
Last Update Date: 10/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 E 138TH ST
BRONX NY
10454-3041
US

IV. Provider business mailing address

248 BAYVILLE AVE P.O. BOX 1357
BAYVILLE NY
11709-1616
US

V. Phone/Fax

Practice location:
  • Phone: 718-292-0100
  • Fax: 347-591-3862
Mailing address:
  • Phone: 516-794-4161
  • Fax: 516-794-9568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1225121
License Number StateNY

VIII. Authorized Official

Name: MS. PATTY RESTIVO
Title or Position: DIRECTOR OF CREDENTIALING
Credential:
Phone: 516-794-4161