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General NPI Number Information
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NPI Number | 1912399437
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Entity Type | Organization
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Legal Business Name | CARDIOVASCULAR SOLUTIONS OF MISSISSIPPI, LLC
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Dates
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Enumeration Date | 02/19/2015
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Last Update Date | 02/19/2015
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Provider Practice Location Address
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Address Line | 657 W MONROE ST
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City | GRENADA
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State | MS
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Zip | 38901-5115
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Country | US
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Telephone | 646-453-9871
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Fax |
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Provider Business Mailing Address
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Address Line | 27 REINER PL
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City | ENGLEWOOD CLIFFS
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State | NJ
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Zip | 07632-2027
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Country | US
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Telephone | 646-453-9871
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | ASHWANI SASTRY
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Credential | MD
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Telephone | 646-453-9871
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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 | 23583
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License Number State | MS
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