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General NPI Number Information
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NPI Number | 1760819783
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Entity Type | Organization
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Legal Business Name | NEW YORK CARDIOVASCULAR MEDICAL IMAGING PC
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Dates
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Enumeration Date | 10/04/2013
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Last Update Date | 10/04/2013
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Provider Practice Location Address
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Address Line | 2109 BROADWAY STE 15-104
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City | NEW YORK
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State | NY
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Zip | 10023-2138
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Country | US
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Telephone | 718-645-1118
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Fax | 718-645-1148
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Provider Business Mailing Address
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Address Line | 2109 BROADWAY STE 15-104
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City | NEW YORK
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State | NY
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Zip | 10023
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Country | US
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Telephone | 718-645-1118
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Fax | 718-645-1148
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. ANNA ZAK
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Credential |
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Telephone | 718-645-1118
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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 | 174875
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License Number State | NY
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