Provider Demographics
NPI:1184676355
Name:NORTH MEDICAL CARDIOVASCULAR GROUP PC
Entity Type:Organization
Organization Name:NORTH MEDICAL CARDIOVASCULAR GROUP PC
Other - Org Name:CARDIOVASCULAR GROUP OF SYRACUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SASSANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-752-0141
Mailing Address - Street 1:6221 STATE ROUTE 31
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-8715
Mailing Address - Country:US
Mailing Address - Phone:315-752-0141
Mailing Address - Fax:315-752-0142
Practice Address - Street 1:4507 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-6604
Practice Address - Country:US
Practice Address - Phone:315-663-0500
Practice Address - Fax:315-663-0514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02130289Medicaid
NY02130289Medicaid