Provider Demographics
NPI:1609241637
Name:WESTCHESTER CARDIOVASCULAR PC
Entity Type:Organization
Organization Name:WESTCHESTER CARDIOVASCULAR PC
Other - Org Name:NYC MEDICAL PLAZA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DMITRY
Authorized Official - Middle Name:
Authorized Official - Last Name:GORELIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:929-321-3684
Mailing Address - Street 1:1111 AVENUE K
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-4117
Mailing Address - Country:US
Mailing Address - Phone:929-321-3684
Mailing Address - Fax:
Practice Address - Street 1:1111 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-2039
Practice Address - Country:US
Practice Address - Phone:929-321-3684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-02
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD238300-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11780525Medicaid
NYC0AAA3048Medicare Oscar/Certification