Healthcare Provider Details

I. General information

NPI: 1669543278
Provider Name (Legal Business Name): CARDIOVASCULAR IMAGING OF BROOKLYN, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 OCEAN PKWY
BROOKLYN NY
11230-5655
US

IV. Provider business mailing address

PO BOX 13055
HAUPPAUGE NY
11788-0541
US

V. Phone/Fax

Practice location:
  • Phone: 718-376-4566
  • Fax: 718-376-8744
Mailing address:
  • Phone: 718-376-4566
  • Fax: 718-376-8744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE MAYER
Title or Position: VP MANAGED CARE & CREDENTIALING
Credential:
Phone: 631-952-5717