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General NPI Number Information
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NPI Number | 1992255350
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Entity Type | Organization
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Legal Business Name | COMMUNITY CARDIOVASCULAR SERVICES, PLLC
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Dates
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Enumeration Date | 10/10/2016
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Last Update Date | 10/10/2016
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Provider Practice Location Address
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Address Line | 117-44, 122ND STREET
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City | SOUTH OZONE PARK
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State | NY
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Zip | 11420
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Country | US
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Telephone | 347-479-6111
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Fax |
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Provider Business Mailing Address
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Address Line | 101-20 LEFFERTS BLVD
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City | RICHMOND HILL
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State | NY
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Zip | 11419
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-DIRECTOR
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Name | JAFFAR RAZA
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Credential | MD
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Telephone | 917-328-0752
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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 | 244275
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License Number State | NY
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