Provider Demographics
NPI:1487829784
Name:CARDIOLOGY CONSULTS OF ROCHESTER
Entity Type:Organization
Organization Name:CARDIOLOGY CONSULTS OF ROCHESTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLER
Authorized Official - Prefix:MS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MATINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-342-4212
Mailing Address - Street 1:2664 RIDGEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4209
Mailing Address - Country:US
Mailing Address - Phone:585-225-5050
Mailing Address - Fax:585-720-0776
Practice Address - Street 1:2664 RIDGEWAY AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4209
Practice Address - Country:US
Practice Address - Phone:585-225-5050
Practice Address - Fax:585-720-0776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY128195207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00541704Medicaid
B72437Medicare UPIN
NY10386AMedicare PIN