Healthcare Provider Details

I. General information

NPI: 1417904434
Provider Name (Legal Business Name): NEW YORK COMPREHENSIVE CARDIOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 07/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 SENECA AVE
RIDGEWOOD NY
11385-4123
US

IV. Provider business mailing address

PO BOX 750782
FOREST HILLS NY
11375-0782
US

V. Phone/Fax

Practice location:
  • Phone: 718-486-4278
  • Fax:
Mailing address:
  • Phone: 718-486-4278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number220423
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number220423
License Number StateNY

VIII. Authorized Official

Name: DR. SANJEEV PALTA
Title or Position: OWNER
Credential: MD
Phone: 718-486-4278