Healthcare Provider Details

I. General information

NPI: 1336147859
Provider Name (Legal Business Name): GRAMERCY CARDIAC DIAGNOSTIC SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 10/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 W 35TH ST FLOOR 7
NEW YORK NY
10001-2111
US

IV. Provider business mailing address

131 W 35TH ST FLOOR 7
NEW YORK NY
10001-2111
US

V. Phone/Fax

Practice location:
  • Phone: 212-475-8066
  • Fax: 212-475-4175
Mailing address:
  • Phone: 212-475-8066
  • Fax: 212-475-4175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number60-144465-1
License Number StateNY

VIII. Authorized Official

Name: MISS VICTORIA MARIN
Title or Position: PRECERTIFICATION/CREDENTIALS
Credential:
Phone: 212-475-8066