Healthcare Provider Details

I. General information

NPI: 1831498740
Provider Name (Legal Business Name): CARDIOVASCULAR ASSOCIATES OF STATEN ISLAND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2011
Last Update Date: 05/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 SEAVIEW AVE SUITE 100
STATEN ISLAND NY
10305-3419
US

IV. Provider business mailing address

501 SEAVIEW AVE SUITE 100
STATEN ISLAND NY
10305-3419
US

V. Phone/Fax

Practice location:
  • Phone: 718-667-0077
  • Fax: 718-667-4103
Mailing address:
  • Phone: 718-667-0077
  • Fax: 718-667-4103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number231108
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number216124
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number198311
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number194645
License Number StateNY

VIII. Authorized Official

Name: DR. TIMOTHY K. O'BYRNE
Title or Position: OWNER
Credential: M.D.
Phone: 718-667-0077