Healthcare Provider Details

I. General information

NPI: 1205983491
Provider Name (Legal Business Name): NEW LIFE CARDIOVASCULAR CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 E WILLOW GROVE AVE # 19038
GLENSIDE PA
19038-7968
US

IV. Provider business mailing address

805 E WILLOW GROVE AVE # 19038
WYNDMOOR PA
19038-7968
US

V. Phone/Fax

Practice location:
  • Phone: 215-966-1546
  • Fax: 215-764-5472
Mailing address:
  • Phone: 215-966-1546
  • Fax: 215-764-5472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL W MILBOURNE
Title or Position: PRESIDENT
Credential: MD
Phone: 215-966-1546