Provider Demographics
NPI:1609907005
Name:FIVE TOWNS HEART IMAGING MEDICAL P.C.
Entity Type:Organization
Organization Name:FIVE TOWNS HEART IMAGING MEDICAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:
Authorized Official - Last Name:SOKOL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-615-7422
Mailing Address - Street 1:650 CENTRAL AVE
Mailing Address - Street 2:SUITE K
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-2301
Mailing Address - Country:US
Mailing Address - Phone:917-846-5707
Mailing Address - Fax:
Practice Address - Street 1:650 CENTRAL AVE
Practice Address - Street 2:SUITE K
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-2301
Practice Address - Country:US
Practice Address - Phone:516-804-8590
Practice Address - Fax:516-804-8591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H46087Medicare UPIN