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General NPI Number Information
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NPI Number | 1225195001
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Entity Type | Organization
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Legal Business Name | LAWRENCE CARDIOVASCULAR ASSOCIATES PC
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 135 ROCKAWAY TPKE STE 103
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City | LAWRENCE
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State | NY
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Zip | 11559-1023
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Country | US
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Telephone | 516-239-1616
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Fax | 516-239-1616
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Provider Business Mailing Address
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Address Line | 135 ROCKAWAY TPKE STE 103
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City | LAWRENCE
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State | NY
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Zip | 11559-1023
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Country | US
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Telephone | 516-239-1616
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Fax | 516-239-2566
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Authorized Official
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Title or Position | PRESIDENT
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Name | RAUL MENDOZA
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Credential | M.D.
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Telephone | 516-239-1616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 135196
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License Number State | NY
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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 | 171383
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License Number State | NY
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