=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598956401
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUND SHORE CARDIOLOGY, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2007
-----------------------------------------------------
Last Update Date | 04/16/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 175 MEMORIAL HWY SUITE 1-1
-----------------------------------------------------
City | NEW ROCHELLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10801-5635
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-235-3535
-----------------------------------------------------
Fax | 914-235-4108
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 175 MEMORIAL HWY SUITE 1-1
-----------------------------------------------------
City | NEW ROCHELLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10801-5635
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-235-3535
-----------------------------------------------------
Fax | 914-235-4108
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE MANAGER
-----------------------------------------------------
Name | JOYCE BODIE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 914-235-3535
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 135255
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------