Provider Demographics
NPI:1588040752
Name:NEW YORK CARDIOVASCULAR CARE AND PREVENTIVE INTERVENTIONS PLLC
Entity Type:Organization
Organization Name:NEW YORK CARDIOVASCULAR CARE AND PREVENTIVE INTERVENTIONS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETER
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-614-9297
Mailing Address - Street 1:PO BOX 26003
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11202-6003
Mailing Address - Country:US
Mailing Address - Phone:718-783-7001
Mailing Address - Fax:718-783-7091
Practice Address - Street 1:240 WILLOUGHBY ST
Practice Address - Street 2:SUITE 10F
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5465
Practice Address - Country:US
Practice Address - Phone:718-783-7001
Practice Address - Fax:718-783-7091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-10
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212389174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty