Provider Demographics
NPI:1114221694
Name:GREAT VALLEY CARDIOLOGY PLLC
Entity Type:Organization
Organization Name:GREAT VALLEY CARDIOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHECHTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-506-6035
Mailing Address - Street 1:6106 E BROWN RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-4954
Mailing Address - Country:US
Mailing Address - Phone:888-506-6035
Mailing Address - Fax:888-506-6037
Practice Address - Street 1:6106 E BROWN RD STE 101
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-4954
Practice Address - Country:US
Practice Address - Phone:888-506-6035
Practice Address - Fax:888-506-6037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-27
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty