=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235422577
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HILLSIDE HEART LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2011
-----------------------------------------------------
Last Update Date | 05/19/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 915 HILLSIDE AVE
-----------------------------------------------------
City | NEW HYDE PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11040-2529
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-799-9136
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14 ELDERBERRY RD
-----------------------------------------------------
City | DIX HILLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11746-5641
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-799-9136
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. SATHEESH JOSEPH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 631-431-3245
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RI0011X
-----------------------------------------------------
Taxonomy Name | Interventional Cardiology Physician
-----------------------------------------------------
License Number | 222332
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------