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General NPI Number Information
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NPI Number | 1518102854
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Entity Type | Organization
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Legal Business Name | QUALITY HEART CARE
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Dates
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Enumeration Date | 12/15/2008
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Last Update Date | 12/15/2008
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Provider Practice Location Address
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Address Line | 116 TERRYVILLE RD
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776-1329
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Country | US
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Telephone | 631-255-3617
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Fax |
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Provider Business Mailing Address
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Address Line | 7 VON HAGEN AVE
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City | SAINT JAMES
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State | NY
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Zip | 11780-2126
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Country | US
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Telephone | 631-255-3617
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. RAVINA BALCHANDANI
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Credential |
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Telephone | 631-255-3617
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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 | 217988
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License Number State | NY
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