Healthcare Provider Details

I. General information

NPI: 1699834705
Provider Name (Legal Business Name): NEW LIFE CARDIOVASCULAR CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 E WILLOW GROVE AVE STE 1C
GLENSIDE PA
19038-7968
US

IV. Provider business mailing address

407 HIGHGATE DR
AMBLER PA
19002-1559
US

V. Phone/Fax

Practice location:
  • Phone: 215-870-4144
  • Fax: 215-793-4488
Mailing address:
  • Phone: 215-870-4144
  • Fax: 215-793-4488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberMD050825L
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL M MILBOURNE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 215-870-4144