Healthcare Provider Details

I. General information

NPI: 1780729111
Provider Name (Legal Business Name): HEARTCARE MEDICAL GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5645 MAIN ST
FLUSHING NY
11355-5045
US

IV. Provider business mailing address

1303 209TH ST
BAYSIDE NY
11360-1123
US

V. Phone/Fax

Practice location:
  • Phone: 718-670-1231
  • Fax:
Mailing address:
  • Phone: 718-279-4300
  • Fax: 718-204-7470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number152102
License Number StateNY

VIII. Authorized Official

Name: MS. EVA LOUDAROS
Title or Position: SERVICE REPRESENTATIVE
Credential:
Phone: 718-204-0414