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General NPI Number Information
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NPI Number | 1003883653
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Entity Type | Organization
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Legal Business Name | PEDIATRIC CARDIOLOGY OF LI PC
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Dates
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Enumeration Date | 03/02/2006
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Last Update Date | 03/25/2013
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Provider Practice Location Address
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Address Line | 100 PORT WASHINGTON BLVD SUITE 108
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City | ROSLYN
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State | NY
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Zip | 11576-1347
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Country | US
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Telephone | 516-365-3340
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Fax | 516-365-5512
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Provider Business Mailing Address
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Address Line | 100 PORT WASHINGTON BLVD SUITE 108
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City | ROSLYN
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State | NY
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Zip | 11576-1347
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Country | US
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Telephone | 516-365-3340
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Fax | 516-365-5512
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Authorized Official
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Title or Position | PARTNER
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Name | AMBROSE M. VALLONE
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Credential | M.D.
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Telephone | 516-365-3340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | 175239
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License Number State | NY
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