Provider Demographics
NPI:1104040054
Name:MANHASSET CARDIOVASCULAR, P.C.
Entity Type:Organization
Organization Name:MANHASSET CARDIOVASCULAR, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:M
Authorized Official - Last Name:PACIENZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-365-5151
Mailing Address - Street 1:75 PLANDOME RD
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-2301
Mailing Address - Country:US
Mailing Address - Phone:516-365-5151
Mailing Address - Fax:516-365-5171
Practice Address - Street 1:75 PLANDOME RD
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-2301
Practice Address - Country:US
Practice Address - Phone:516-365-5151
Practice Address - Fax:516-365-5171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY156218174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A61026Medicare UPIN
WAC761Medicare ID - Type Unspecified