Healthcare Provider Details

I. General information

NPI: 1609907005
Provider Name (Legal Business Name): FIVE TOWNS HEART IMAGING MEDICAL P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 11/06/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 CENTRAL AVE SUITE K
CEDARHURST NY
11516-2301
US

IV. Provider business mailing address

650 CENTRAL AVE SUITE K
CEDARHURST NY
11516-2301
US

V. Phone/Fax

Practice location:
  • Phone: 516-804-8590
  • Fax: 516-804-8591
Mailing address:
  • Phone: 917-846-5707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SERGIO SOKOL
Title or Position: OWNER
Credential: MD
Phone: 718-615-7422