Provider Demographics
NPI:1326130808
Name:CARDIOVASCULAR HEALTH CENTER PA
Entity Type:Organization
Organization Name:CARDIOVASCULAR HEALTH CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:ZULIMA
Authorized Official - Middle Name:A
Authorized Official - Last Name:NICOLOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-855-1520
Mailing Address - Street 1:PO BOX 568217
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32856-8217
Mailing Address - Country:US
Mailing Address - Phone:407-855-1520
Mailing Address - Fax:407-855-1590
Practice Address - Street 1:3802 OAKWATER CIR
Practice Address - Street 2:SUITE 2
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-6200
Practice Address - Country:US
Practice Address - Phone:407-855-1520
Practice Address - Fax:407-855-1590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0049316207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14550XOtherECG READING PANEL, INC.
FL1598857294OtherNPPES
FLCW638AMedicare PIN