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General NPI Number Information
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NPI Number | 1780729111
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Entity Type | Organization
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Legal Business Name | HEARTCARE MEDICAL GROUP, PLLC
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5645 MAIN ST
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City | FLUSHING
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State | NY
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Zip | 11355-5045
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Country | US
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Telephone | 718-670-1231
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Fax |
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Provider Business Mailing Address
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Address Line | 1303 209TH ST
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City | BAYSIDE
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State | NY
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Zip | 11360-1123
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Country | US
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Telephone | 718-279-4300
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Fax | 718-204-7470
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Authorized Official
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Title or Position | SERVICE REPRESENTATIVE
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Name | MS. EVA LOUDAROS
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Credential |
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Telephone | 718-204-0414
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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 | 152102
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License Number State | NY
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