Healthcare Provider Details

I. General information

NPI: 1033379557
Provider Name (Legal Business Name): CARDIAC IMAGING, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

3671 SOUTHWESTERN BLVD SUITE 107
ORCHARD PARK NY
14127-1752
US

IV. Provider business mailing address

908 NIAGARA FALLS BLVD SUITE 208
N TONAWANDA NY
14120-2019
US

V. Phone/Fax

Practice location:
  • Phone: 716-667-2062
  • Fax: 716-667-2063
Mailing address:
  • Phone: 716-692-3302
  • Fax: 716-362-9518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number199233
License Number StateNY

VIII. Authorized Official

Name: DAVID AVINO
Title or Position: OWNER
Credential: MD
Phone: 716-667-2062