Provider Demographics
NPI:1679148464
Name:COMPLETE HEART AND VASCULAR CARE PC
Entity Type:Organization
Organization Name:COMPLETE HEART AND VASCULAR CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANKUR
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-491-7611
Mailing Address - Street 1:306 GOLD ST APT 24C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-3038
Mailing Address - Country:US
Mailing Address - Phone:412-491-7611
Mailing Address - Fax:917-300-2785
Practice Address - Street 1:2051 FLATBUSH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-3523
Practice Address - Country:US
Practice Address - Phone:917-300-2728
Practice Address - Fax:917-300-2785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-24
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY258269OtherSTATE LICENSE