MEDICARE: STATWIDE CARDIOVASCULAR.P.C

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	:	1841563657
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STATWIDE CARDIOVASCULAR.P.C

Provider Business Mailing Address
First Line	:	5847 FRANCIS LEWIS BLVD
Second Line	:	SUITE14
City	:	FLUSHING
State	:	NY
Zip	:	11364-1698
Country	:	US
Telephone Number	:	718-224-6969
Fax Number	:

Provider Business Practice Location Address
First Line	:	5847 FRANCIS LEWIS BLVD
Second Line	:	SUITE14
City	:	FLUSHING
State	:	NY
Zip	:	11364-1698
Country	:	US
Telephone Number	:	718-224-6969
Fax Number	:

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	NALINIE KISTEN
Credential	:
Telephone Number	:	718-224-6969

Provider Enumeration Date	:	02/10/2012
Last Update Date	:	02/10/2012

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