Provider Demographics
NPI:1639154891
Name:NEW YORK CARDIAC DIAGNOSTIC CENTER
Entity Type:Organization
Organization Name:NEW YORK CARDIAC DIAGNOSTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:REISMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-860-0796
Mailing Address - Street 1:115 E 86TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-1057
Mailing Address - Country:US
Mailing Address - Phone:212-860-0796
Mailing Address - Fax:212-860-1946
Practice Address - Street 1:115 E 86TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-1057
Practice Address - Country:US
Practice Address - Phone:212-860-0796
Practice Address - Fax:212-860-1946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-09
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02517531Medicaid
NYW15121Medicare ID - Type Unspecified
NY02517531Medicaid