Provider Demographics
NPI:1376713180
Name:RYE BROOK CARDIOLOGY & VASCULAR MEDICINE, P.C.
Entity Type:Organization
Organization Name:RYE BROOK CARDIOLOGY & VASCULAR MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MYUNG
Authorized Official - Middle Name:HO
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-251-1070
Mailing Address - Street 1:14 RYE RIDGE PLZ
Mailing Address - Street 2:STE. 234
Mailing Address - City:RYE BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:10573-2826
Mailing Address - Country:US
Mailing Address - Phone:914-251-1070
Mailing Address - Fax:914-935-9047
Practice Address - Street 1:14 RYE RIDGE PLZ
Practice Address - Street 2:STE. 234
Practice Address - City:RYE BROOK
Practice Address - State:NY
Practice Address - Zip Code:10573-2826
Practice Address - Country:US
Practice Address - Phone:914-251-1070
Practice Address - Fax:914-935-9047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182644174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060001666Medicare PIN
CTC03351Medicare PIN
G35568Medicare UPIN