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General NPI Number Information
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NPI Number | 1043483274
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Entity Type | Organization
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Legal Business Name | GRAND CORNELL CARDIOLOGY PC
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Dates
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Enumeration Date | 04/09/2008
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Last Update Date | 08/03/2012
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Provider Practice Location Address
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Address Line | 217 GRAND ST FL 9
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City | NEW YORK
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State | NY
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Zip | 10013-4223
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Country | US
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Telephone | 212-233-8813
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Fax | 212-267-3303
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Provider Business Mailing Address
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Address Line | 217 GRAND ST FL 9
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City | NEW YORK
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State | NY
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Zip | 10013-4223
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Country | US
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Telephone | 212-233-8813
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Fax | 212-267-3303
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KENNETH C. TAM
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Credential | M.D., F.A.C.C
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Telephone | 212-233-8813
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 173277
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License Number State | NY
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