Provider Demographics
NPI:1639249493
Name:D C CARDIOLOGY CARE PLLC
Entity Type:Organization
Organization Name:D C CARDIOLOGY CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORIGINAL MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIKVASHVILI
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:516-395-5907
Mailing Address - Street 1:111-15 QUEENS BLVD, SECOND FLOOR
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375
Mailing Address - Country:US
Mailing Address - Phone:718-916-9757
Mailing Address - Fax:516-921-2530
Practice Address - Street 1:111-15 QUEENS BLVD, SECOND FLOOR
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:718-916-9757
Practice Address - Fax:516-921-2530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220385207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
07882Medicare PIN