Healthcare Provider Details

I. General information

NPI: 1396141503
Provider Name (Legal Business Name): NY CARDIAC & VASCULAR PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2014
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
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 61507
STATEN ISLAND NY
10306-7507
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 TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

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