MEDICARE: COMPLETE HEART AND VASCULAR CARE 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	258269	OTHER	NY	STATE LICENSE

General Provider Information

NPI Number	:	1679148464
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPLETE HEART AND VASCULAR CARE PC

Provider Business Mailing Address
First Line	:	9 WILLOW ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-1334
Country	:	US
Telephone Number	:	917-300-2728
Fax Number	:	917-300-2785

Provider Business Practice Location Address
First Line	:	2051 FLATBUSH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-3523
Country	:	US
Telephone Number	:	917-300-2728
Fax Number	:	917-300-2785

Authorized Official
Title or Position	:	CEO
Name	:	ANKUR SHAH
Credential	:	MD
Telephone Number	:	412-491-7611

Provider Enumeration Date	:	05/24/2021
Last Update Date	:	07/03/2024

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