Healthcare Provider Details

I. General information

NPI: 1851594956
Provider Name (Legal Business Name): NEW YORK CARDIOVASCULAR SPECIALIST PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1787 MADISON AVE SUITE 50C
NEW YORK NY
10035-4518
US

IV. Provider business mailing address

PO BOX 1170
NEW YORK NY
10035-0825
US

V. Phone/Fax

Practice location:
  • Phone: 212-348-9400
  • Fax: 212-348-9405
Mailing address:
  • Phone: 212-348-9400
  • Fax: 212-348-9405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number219132
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number219132
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number219132
License Number StateNY

VIII. Authorized Official

Name: DR. HENOCK SAINT-JACQUES
Title or Position: OWNER
Credential: M.D.
Phone: 914-462-2090