MEDICARE: CARDIOVASCULAR IMAGING OF BROOKLYN, 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	207UN0901X	Nuclear Cardiology Physician

General Provider Information

NPI Number	:	1669543278
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIOVASCULAR IMAGING OF BROOKLYN, PC

Provider Business Mailing Address
First Line	:	PO BOX 13055
Second Line	:
City	:	HAUPPAUGE
State	:	NY
Zip	:	11788-0541
Country	:	US
Telephone Number	:	718-376-4566
Fax Number	:	718-376-8744

Provider Business Practice Location Address
First Line	:	1335 OCEAN PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-5655
Country	:	US
Telephone Number	:	718-376-4566
Fax Number	:	718-376-8744

Authorized Official
Title or Position	:	VP MANAGED CARE & CREDENTIALING
Name	:	JACQUELINE MAYER
Credential	:
Telephone Number	:	631-952-5717

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	08/22/2020

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