MEDICARE: NEW YORK HEART AND VASCULAR SPECIALISTS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0011X	Interventional Cardiology Physician

General Provider Information

NPI Number	:	1003180738
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW YORK HEART AND VASCULAR SPECIALISTS PC

Provider Business Mailing Address
First Line	:	3309 CHURCH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-2711
Country	:	US
Telephone Number	:	347-425-1789
Fax Number	:	347-240-4434

Provider Business Practice Location Address
First Line	:	3309 CHURCH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-2711
Country	:	US
Telephone Number	:	347-425-1789
Fax Number	:	347-240-4434

Authorized Official
Title or Position	:	OWNER
Name	:	GOPI K PUNUKOLLY
Credential	:	MD
Telephone Number	:	347-425-1789

Provider Enumeration Date	:	02/27/2012
Last Update Date	:	02/27/2012

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