Healthcare Provider Details

I. General information

NPI: 1396905600
Provider Name (Legal Business Name): HEART PHYSICIANS INTERVENTIONAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 10/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 FORT WASHINGTON AVE
NEW YORK NY
10032-3729
US

IV. Provider business mailing address

161 FORT WASHINGTON AVE
NEW YORK NY
10032-3729
US

V. Phone/Fax

Practice location:
  • Phone: 203-348-7410
  • Fax: 203-961-8488
Mailing address:
  • Phone: 203-348-7410
  • Fax: 203-961-8488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number102630
License Number StateCT

VIII. Authorized Official

Name: RICHARD LANDESMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 203-348-7410