Provider Demographics
NPI:1467462978
Name:CARDIOLOGY CONSULTANTS OF LONG ISLAND, PC
Entity Type:Organization
Organization Name:CARDIOLOGY CONSULTANTS OF LONG ISLAND, PC
Other - Org Name:CARDIOLOGY CONSULTANTS OF LONG ISLAND PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THIERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUCHATELLIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-678-1444
Mailing Address - Street 1:2000 NORTH VILLAGE AVE
Mailing Address - Street 2:SUITE # 106-108
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570
Mailing Address - Country:US
Mailing Address - Phone:516-678-1444
Mailing Address - Fax:516-678-1023
Practice Address - Street 1:2000 NORTH VILLAGE AVE
Practice Address - Street 2:SUITE # 106-108
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570
Practice Address - Country:US
Practice Address - Phone:516-678-1444
Practice Address - Fax:516-678-1023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206601207R00000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW6Z981Medicare ID - Type Unspecified