Provider Demographics
NPI:1215042213
Name:ASSOCIATED CARDIOLOGY CONSULTANT PC
Entity Type:Organization
Organization Name:ASSOCIATED CARDIOLOGY CONSULTANT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:SHAIK
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-850-0707
Mailing Address - Street 1:37 CLIFTON ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-5500
Mailing Address - Country:US
Mailing Address - Phone:631-777-3155
Mailing Address - Fax:631-777-3154
Practice Address - Street 1:10120 LEFFERTS BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419-2006
Practice Address - Country:US
Practice Address - Phone:718-850-0707
Practice Address - Fax:718-850-9405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY192787207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01720061Medicaid
NYX20951Medicare UPIN
NY01720061Medicaid
NYW1L621Medicare PIN