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General NPI Number Information
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NPI Number | 1023356144
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Entity Type | Organization
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Legal Business Name | CARDIOLOGY CONSULTANTS OF GREATER PHILADELPHIA PC
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Dates
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Enumeration Date | 01/24/2013
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Last Update Date | 03/28/2013
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Provider Practice Location Address
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Address Line | 10752 BUSTLETON AVE SUITE G
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City | PHILADELPHIA
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State | PA
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Zip | 19116-3367
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Country | US
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Telephone | 267-307-9236
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Fax |
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Provider Business Mailing Address
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Address Line | 1420 LOCUST ST APT. 23P
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City | PHILADELPHIA
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State | PA
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Zip | 19102-4223
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Country | US
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Telephone | 267-307-9236
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | IRINA M JOUKOVA
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Credential | M.D., PH.D.
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Telephone | 267-307-9236
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD435017
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 25MA08508800
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | MD435017
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License Number State | PA
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