Provider Demographics
NPI:1710289319
Name:ADVANCED MEDICAL AND CARDIOVASCULAR DISEASE SOLUTION
Entity Type:Organization
Organization Name:ADVANCED MEDICAL AND CARDIOVASCULAR DISEASE SOLUTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANMOO
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:RIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-463-0101
Mailing Address - Street 1:4522 162ND ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-3280
Mailing Address - Country:US
Mailing Address - Phone:718-463-0101
Mailing Address - Fax:718-961-3850
Practice Address - Street 1:4522 162ND ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-3280
Practice Address - Country:US
Practice Address - Phone:718-463-0101
Practice Address - Fax:718-961-3850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129036207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00585846Medicaid
NY00585846Medicaid