Healthcare Provider Details

I. General information

NPI: 1699761197
Provider Name (Legal Business Name): S J H CARDIAC CATHETERIZATION ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 03/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4820 W TAFT RD SUITE 209
LIVERPOOL NY
13088-2800
US

IV. Provider business mailing address

4820 W TAFT RD SUITE 209
LIVERPOOL NY
13088-2800
US

V. Phone/Fax

Practice location:
  • Phone: 315-448-6215
  • Fax: 315-234-4416
Mailing address:
  • Phone: 315-448-6215
  • Fax: 315-234-4416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: ALI AL-MUDAMGHA
Title or Position: PRESIDENT
Credential: MD
Phone: 315-234-0906