Provider Demographics
NPI:1659664480
Name:CROWLEY CARDIAC WELLNESS LLC
Entity Type:Organization
Organization Name:CROWLEY CARDIAC WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NITIN
Authorized Official - Middle Name:LOURDES
Authorized Official - Last Name:MALLA
Authorized Official - Suffix:
Authorized Official - Credentials:GENERAL PARTNER
Authorized Official - Phone:914-494-3803
Mailing Address - Street 1:1113 E NORTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70526-3035
Mailing Address - Country:US
Mailing Address - Phone:337-680-4877
Mailing Address - Fax:337-205-7972
Practice Address - Street 1:1113 E NORTHERN AVE
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-3035
Practice Address - Country:US
Practice Address - Phone:337-680-4877
Practice Address - Fax:337-205-7972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology