Healthcare Provider Details

I. General information

NPI: 1053471649
Provider Name (Legal Business Name): CARITAS CARDIOLOGY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 09/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9002 QUEENS BLVD
ELMHURST NY
11373-4941
US

IV. Provider business mailing address

9002 QUEENS BLVD
ELMHURST NY
11373-4941
US

V. Phone/Fax

Practice location:
  • Phone: 718-558-1830
  • Fax: 718-558-1878
Mailing address:
  • Phone: 718-558-1830
  • Fax: 718-558-1878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOANNE CAMPBELL
Title or Position: DIRECTOR
Credential:
Phone: 717-625-1338