Provider Demographics
NPI:1235917691
Name:CARDINAL NY CORPORATION
Entity Type:Organization
Organization Name:CARDINAL NY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ARCHIL
Authorized Official - Middle Name:
Authorized Official - Last Name:ARJEVANIDZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-220-1152
Mailing Address - Street 1:8808 ROCKAWAY BEACH BLVD UNIT 209
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY BCH
Mailing Address - State:NY
Mailing Address - Zip Code:11693-1608
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8808 ROCKAWAY BEACH BLVD UNIT 209
Practice Address - Street 2:
Practice Address - City:ROCKAWAY BCH
Practice Address - State:NY
Practice Address - Zip Code:11693-1608
Practice Address - Country:US
Practice Address - Phone:917-254-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty