Healthcare Provider Details

I. General information

NPI: 1942294707
Provider Name (Legal Business Name): PRIMARY CARDIOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 RALPH PL SUITE 310
STATEN ISLAND NY
10304-4419
US

IV. Provider business mailing address

11 RALPH PL SUITE 310
STATEN ISLAND NY
10304-4419
US

V. Phone/Fax

Practice location:
  • Phone: 718-442-1777
  • Fax: 718-448-5260
Mailing address:
  • Phone: 718-442-1777
  • Fax: 718-448-5260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number StateNY

VIII. Authorized Official

Name: LOUIS MITCHELL BESSER
Title or Position: MEDICAL DOCTOR
Credential: MD FACC
Phone: 718-442-1777