Provider Demographics
NPI:1144738832
Name:HEART CENTER PLLC
Entity Type:Organization
Organization Name:HEART CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-674-1810
Mailing Address - Street 1:215 STILLWATER AVE.
Mailing Address - Street 2:UNIT B
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-4807
Mailing Address - Country:US
Mailing Address - Phone:203-674-1810
Mailing Address - Fax:203-674-1805
Practice Address - Street 1:215 STILLWATER AVE.
Practice Address - Street 2:UNIT B
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-4807
Practice Address - Country:US
Practice Address - Phone:203-674-1810
Practice Address - Fax:203-674-1805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-16
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT207RC0000X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Multi-Specialty