Healthcare Provider Details

I. General information

NPI: 1790937910
Provider Name (Legal Business Name): THE CARDIOLOGY GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 01/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 COMMUNITY DR SUITE 130
GREAT NECK NY
11021-5506
US

IV. Provider business mailing address

225 COMMUNITY DR SUITE 130
GREAT NECK NY
11021-5506
US

V. Phone/Fax

Practice location:
  • Phone: 516-504-0474
  • Fax: 516-504-0477
Mailing address:
  • Phone: 516-504-0474
  • Fax: 516-504-0477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number150518
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number227230
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number108705
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number116929
License Number StateNY

VIII. Authorized Official

Name: DR. ROBERT J DRESDALE
Title or Position: PHYSICIAN
Credential: MD
Phone: 516-504-0474