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General NPI Number Information
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NPI Number | 1891872610
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Entity Type | Organization
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Legal Business Name | ROOSEVELT CARDIOLOGY PC
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 09/07/2012
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Provider Practice Location Address
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Address Line | 3660 MAIN ST SUITE 2S
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City | FLUSHING
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State | NY
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Zip | 11354-6507
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Country | US
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Telephone | 718-888-1656
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Fax | 718-886-2336
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Provider Business Mailing Address
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Address Line | 3660 MAIN ST SUITE 2S
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City | FLUSHING
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State | NY
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Zip | 11354-6559
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Country | US
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Telephone | 718-888-1656
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Fax | 718-886-2336
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Authorized Official
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Title or Position | SHAREHOLDER
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Name | DR. SUNGWAI CHIU
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Credential | M.D.
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Telephone | 718-888-1656
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 201269
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License Number State | NY
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