Provider Demographics
NPI:1326015876
Name:EASTERN CARDIOVASCULAR DIAGNOSTIC, INC.
Entity Type:Organization
Organization Name:EASTERN CARDIOVASCULAR DIAGNOSTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:M
Authorized Official - Last Name:PENTZKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-780-0991
Mailing Address - Street 1:PO BOX 56378
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-6878
Mailing Address - Country:US
Mailing Address - Phone:787-780-0991
Mailing Address - Fax:787-785-0844
Practice Address - Street 1:1 CALLE HERMINIO MIRANDA
Practice Address - Street 2:
Practice Address - City:MOROVIS
Practice Address - State:PR
Practice Address - Zip Code:00687-3032
Practice Address - Country:US
Practice Address - Phone:787-780-0991
Practice Address - Fax:787-785-0844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR74409207RC0000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0082040Medicare ID - Type Unspecified