Provider Demographics
NPI:1710974613
Name:CARDIOVASCULAR SPECIALISTS PC
Entity Type:Organization
Organization Name:CARDIOVASCULAR SPECIALISTS PC
Other - Org Name:NEW YORK HEART CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:GORRA
Authorized Official - Suffix:
Authorized Official - Credentials:COO
Authorized Official - Phone:315-671-1400
Mailing Address - Street 1:1000 E GENESEE ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1892
Mailing Address - Country:US
Mailing Address - Phone:315-471-1044
Mailing Address - Fax:315-474-4312
Practice Address - Street 1:1000 E GENESEE ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1892
Practice Address - Country:US
Practice Address - Phone:315-471-1044
Practice Address - Fax:315-474-4312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00769099Medicaid
NY39085AMedicare PIN