Healthcare Provider Details

I. General information

NPI: 1649339011
Provider Name (Legal Business Name): COMPREHENSIVE CARDIAC CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 STONELEIGH AVE STE 111
CARMEL NY
10512-3997
US

IV. Provider business mailing address

670 STONELEIGH AVE STE 111
CARMEL NY
10512-3997
US

V. Phone/Fax

Practice location:
  • Phone: 845-279-3900
  • Fax: 845-279-4301
Mailing address:
  • Phone: 845-279-3900
  • Fax: 845-279-4301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. KATHRYN BUTO
Title or Position: OFFICE MANAGER
Credential: RN,CPC
Phone: 845-279-3900