Provider Demographics
NPI:1164530309
Name:COMPLETECARE CARDIOLOGY PLLC
Entity Type:Organization
Organization Name:COMPLETECARE CARDIOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:KIEWE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-775-0055
Mailing Address - Street 1:2001 MARCUS AVE
Mailing Address - Street 2:SUITE W285
Mailing Address - City:LAKE SUCCESS
Mailing Address - State:NY
Mailing Address - Zip Code:11042
Mailing Address - Country:US
Mailing Address - Phone:516-775-0055
Mailing Address - Fax:516-775-4647
Practice Address - Street 1:2001 MARCUS AVE
Practice Address - Street 2:SUITE W285
Practice Address - City:LAKE SUCCESS
Practice Address - State:NY
Practice Address - Zip Code:11042
Practice Address - Country:US
Practice Address - Phone:516-775-0055
Practice Address - Fax:516-775-4647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY349AXOtherEMPIRE BLUE CROSS BLUE SHIELD
NY349AXOtherEMPIRE BLUE CROSS BLUE SHIELD
NYWFW241Medicare ID - Type Unspecified