=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174807127
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTEGRATIVE CARDIOLOGY PRACTICE, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2011
-----------------------------------------------------
Last Update Date | 09/02/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 635 MADISON AVE 3RD FLOOR
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10022-1009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-926-3384
-----------------------------------------------------
Fax | 866-795-9603
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7502 AUSTIN ST #6A
-----------------------------------------------------
City | FOREST HILLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11375-6237
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-926-3384
-----------------------------------------------------
Fax | 866-795-9603
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | DR. HOWARD SCHWARTZ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 646-926-3384
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number | 245042
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------