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	207RC0000X	Cardiovascular Disease Physician	244121	NY

General Provider Information

NPI Number	:	1649585399
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	:	347-350-9344
Fax Number	:	718-693-4176

Provider Business Practice Location Address
First Line	:	3309 CHURCH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-2711
Country	:	US
Telephone Number	:	347-350-9344
Fax Number	:	718-693-4176

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. GOPI KRISHNA PUNUKOLLU
Credential	:	M.D.
Telephone Number	:	347-350-9344

Provider Enumeration Date	:	08/18/2010
Last Update Date	:	08/18/2010

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