Provider Demographics
NPI:1457450538
Name:MEDICAL SERVICE OF ST VINCENT'S HOSPITAL &MEDICAL CENTER, P.C.
Entity Type:Organization
Organization Name:MEDICAL SERVICE OF ST VINCENT'S HOSPITAL &MEDICAL CENTER, P.C.
Other - Org Name:MEDICAL SERVICES-CARDIOLOGY
Other - Org Type:Other Name
Authorized Official - Title/Position:SENIOR VP OF REVENUE CYCLE
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CALDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-356-5944
Mailing Address - Street 1:450 W 33RD ST
Mailing Address - Street 2:12TH FLOOR, PBS
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-2603
Mailing Address - Country:US
Mailing Address - Phone:212-356-4474
Mailing Address - Fax:212-356-4608
Practice Address - Street 1:170 W 12TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8202
Practice Address - Country:US
Practice Address - Phone:202-604-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01214933Medicaid
NYW20331Medicare ID - Type Unspecified