Healthcare Provider Details

I. General information

NPI: 1174022552
Provider Name (Legal Business Name): ISLAND CARDIOVASCULAR, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2018
Last Update Date: 02/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 SOUTH AVE STE B
STATEN ISLAND NY
10314-3410
US

IV. Provider business mailing address

PO BOX 219
NEW YORK NY
10028-0016
US

V. Phone/Fax

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

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: MOHAMMAD ZGHEIB
Title or Position: MD
Credential: MD
Phone: 718-761-8800