=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790978203
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEV CARDIOVASCULAR CARE PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2007
-----------------------------------------------------
Last Update Date | 09/06/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9931 64TH AVE SUITE G1
-----------------------------------------------------
City | REGO PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11374-2652
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-897-3541
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9931 64TH AVE SUITE G1
-----------------------------------------------------
City | REGO PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11374-2652
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-897-3541
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE OWNER
-----------------------------------------------------
Name | DR. FARSHID RADPARVAR
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 718-897-3541
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number | 181525
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------