Provider Demographics
NPI:1083874911
Name:INTEGRATED CARDIOVASCULAR IMAGING PLLC
Entity Type:Organization
Organization Name:INTEGRATED CARDIOVASCULAR IMAGING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALAIN
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:FEDIDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-755-3023
Mailing Address - Street 1:45 W 60TH ST
Mailing Address - Street 2:#31-H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-7940
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5 E 59TH ST
Practice Address - Street 2:6TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1027
Practice Address - Country:US
Practice Address - Phone:212-755-3023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172083293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01129006Medicaid
NY01129006Medicaid
NY93H793Medicare PIN