Provider Demographics
NPI:1598105793
Name:CARDIOVASCULAR WELLNESS SPECIALTY CARE PC
Entity Type:Organization
Organization Name:CARDIOVASCULAR WELLNESS SPECIALTY CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMEETA
Authorized Official - Middle Name:
Authorized Official - Last Name:AHUJA WALIA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:914-437-5850
Mailing Address - Street 1:2001 MARCUS AVENUE
Mailing Address - Street 2:SUITE N210
Mailing Address - City:LAKE SUCCESS
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1035
Mailing Address - Country:US
Mailing Address - Phone:516-354-3278
Mailing Address - Fax:516-354-2700
Practice Address - Street 1:2001 MARCUS AVENUE
Practice Address - Street 2:SUITE N210
Practice Address - City:LAKE SUCCESS
Practice Address - State:NY
Practice Address - Zip Code:11042-1035
Practice Address - Country:US
Practice Address - Phone:516-354-3278
Practice Address - Fax:516-354-2700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-02
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232789207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty