Healthcare Provider Details

I. General information

NPI: 1053388397
Provider Name (Legal Business Name): PHOENIX CARDIOVASCULAR, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 STEWART AVE LL16
GARDEN CITY NY
11530-4783
US

IV. Provider business mailing address

100 MYLES STANDISH BLVD
TAUNTON MA
02780-7321
US

V. Phone/Fax

Practice location:
  • Phone: 508-880-3700
  • Fax:
Mailing address:
  • Phone: 508-880-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: CHERYL A FORD
Title or Position: CEO
Credential:
Phone: 508-880-3700