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General NPI Number Information
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NPI Number | 1851042568
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Entity Type | Organization
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Legal Business Name | CITY HEART VASCULAR PLLC
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Dates
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Enumeration Date | 01/13/2022
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Last Update Date | 11/13/2023
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Provider Practice Location Address
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Address Line | 12508 LIBERTY AVE
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City | SOUTH RICHMOND HILL
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State | NY
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Zip | 11419-2234
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Country | US
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Telephone | 718-581-8093
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Fax | 929-990-2928
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Provider Business Mailing Address
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Address Line | 12508 LIBERTY AVE
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City | SOUTH RICHMOND HILL
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State | NY
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Zip | 11419-2234
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Country | US
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Telephone | 718-581-8093
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Fax | 929-990-2928
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Authorized Official
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Title or Position | PRESIDENT
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Name | SRINIVAS KESANAKURTHY
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Credential | MD
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Telephone | 718-581-8093
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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