=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548590409
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARDIOVASCULAR CONSULTING OF NEW YORK, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/28/2009
-----------------------------------------------------
Last Update Date | 01/27/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 36 7TH AVE
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10011-6609
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-367-8000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 36 7TH AVE
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10011-6609
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-367-8000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MARK SELDON
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 212-367-8000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 117243
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------