Provider Demographics
NPI:1396829149
Name:TOTAL HEART CARE PC
Entity Type:Organization
Organization Name:TOTAL HEART CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NIECA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-289-2045
Mailing Address - Street 1:177 E 87TH ST
Mailing Address - Street 2:SUITE 503
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-2226
Mailing Address - Country:US
Mailing Address - Phone:212-289-2045
Mailing Address - Fax:
Practice Address - Street 1:177 E 87TH ST
Practice Address - Street 2:SUITE 503
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-2226
Practice Address - Country:US
Practice Address - Phone:212-289-2045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY163655207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
096526066OtherGALAXY HEALTH NETWORK
0546091OtherCIGNA HEALTH PLANS
4315996OtherAETNA HEALTH PLANS
0738716001OtherAMERIHEALTH
NY488Q62OtherEMPIRE BC/BS
P2845392OtherOXFORD HEALTH PLANS
96526066OtherONE HEALTH PLAN
NYO1241336Medicaid
96526066OtherONE HEALTH PLAN
P2845392OtherOXFORD HEALTH PLANS
NY32F202Medicare ID - Type Unspecified