=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144828542
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMPIRE CITY HEART AND VASCULAR SPECIALISTS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2020
-----------------------------------------------------
Last Update Date | 08/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1600 STEWART AVE STE 105
-----------------------------------------------------
City | WESTBURY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11590-6611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-833-5505
-----------------------------------------------------
Fax | 516-833-5566
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 33 OLD WHEATLEY RD
-----------------------------------------------------
City | GLEN HEAD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11545-2611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-833-5505
-----------------------------------------------------
Fax | 516-833-5566
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KARTHIK R GUJJA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 516-833-5505
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------