Provider Demographics
NPI:1497773394
Name:PREMIER CARDIOLOGY CONSULTANTS, PLLC
Entity Type:Organization
Organization Name:PREMIER CARDIOLOGY CONSULTANTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUMIT
Authorized Official - Middle Name:
Authorized Official - Last Name:MITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-437-5600
Mailing Address - Street 1:2001 MARCUS AVE
Mailing Address - Street 2:SUITE N-122
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1011
Mailing Address - Country:US
Mailing Address - Phone:516-437-5600
Mailing Address - Fax:516-437-7428
Practice Address - Street 1:2001 MARCUS AVE
Practice Address - Street 2:SUITE N-122
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1011
Practice Address - Country:US
Practice Address - Phone:516-437-5600
Practice Address - Fax:516-437-7428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY DOES NOT ISSUE207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEY671Medicare ID - Type UnspecifiedGROUP NUMBER