Healthcare Provider Details

I. General information

NPI: 1073859203
Provider Name (Legal Business Name): NY CARDIO CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2012
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 SOUTH AVE
STATEN ISLAND NY
10314
US

IV. Provider business mailing address

1112 SOUTH AVE
STATEN ISLAND NY
10314
US

V. Phone/Fax

Practice location:
  • Phone: 718-761-8800
  • Fax: 718-761-8804
Mailing address:
  • Phone: 718-761-8800
  • Fax: 718-761-8804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MOHAMMAD H ZGHEIB
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 718-761-8800