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General NPI Number Information
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NPI Number | 1124232202
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Entity Type | Organization
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Legal Business Name | CARDIAC COMMUNITY CARE
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2475 SAINT RAYMONDS AVE 4TH FLOOR
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City | BRONX
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State | NY
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Zip | 10461-3124
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Country | US
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Telephone | 718-239-5877
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Fax | 718-239-6957
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Provider Business Mailing Address
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Address Line | 2475 SAINT RAYMONDS AVE 4TH FLOOR
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City | BRONX
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State | NY
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Zip | 10461-3124
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Country | US
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Telephone | 718-239-5877
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Fax | 718-239-6957
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Authorized Official
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Title or Position | SUPERVISOR
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Name | DR. HAL N. KLESTZICK
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Credential | D.O.
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Telephone | 718-239-5877
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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 | 195483
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License Number State | NY
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