Provider Demographics
NPI:1578707873
Name:QUEENS CARDIOVASCULAR SERVICES PLLC
Entity Type:Organization
Organization Name:QUEENS CARDIOVASCULAR SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TROULAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-278-0100
Mailing Address - Street 1:3018 37TH ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-3809
Mailing Address - Country:US
Mailing Address - Phone:718-278-0100
Mailing Address - Fax:718-278-1143
Practice Address - Street 1:2747 CRESCENT ST S
Practice Address - Street 2:SUITE 201
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-3142
Practice Address - Country:US
Practice Address - Phone:718-278-0100
Practice Address - Fax:718-278-1143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY137457-1207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B14237Medicare UPIN