Provider Demographics
NPI:1700010121
Name:FIVE TOWNS HEART IMAGING MEDICAL, PC
Entity Type:Organization
Organization Name:FIVE TOWNS HEART IMAGING MEDICAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:OSTROVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-884-2132
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:516-884-2132
Mailing Address - Fax:516-804-8591
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:516-884-2132
Practice Address - Fax:516-804-8591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-13
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherTAX IDENTIFICATION NUMBER