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General NPI Number Information
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NPI Number | 1235392036
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Entity Type | Organization
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Legal Business Name | HEART AND VASCULAR CONSULTING OF LONG ISLAND, PC
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Dates
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Enumeration Date | 07/02/2008
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Last Update Date | 07/02/2008
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Provider Practice Location Address
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Address Line | 1630 DEER PARK AVE
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City | DEER PARK
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State | NY
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Zip | 11729-5210
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Country | US
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Telephone | 631-242-6166
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Fax | 631-242-0728
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Provider Business Mailing Address
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Address Line | 1630 DEER PARK AVE
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City | DEER PARK
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State | NY
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Zip | 11729-5210
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Country | US
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Telephone | 631-242-6166
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Fax | 631-242-0728
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Authorized Official
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Title or Position | PRESIDENT
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Name | JERRY A SOKOL
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Credential | MD
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Telephone | 631-242-6166
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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 | 140169
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License Number State | NY
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