Provider Demographics
NPI:1790937910
Name:THE CARDIOLOGY GROUP, PLLC
Entity Type:Organization
Organization Name:THE CARDIOLOGY GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:DRESDALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-504-0474
Mailing Address - Street 1:225 COMMUNITY DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5506
Mailing Address - Country:US
Mailing Address - Phone:516-504-0474
Mailing Address - Fax:516-504-0477
Practice Address - Street 1:225 COMMUNITY DR
Practice Address - Street 2:SUITE 130
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5506
Practice Address - Country:US
Practice Address - Phone:516-504-0474
Practice Address - Fax:516-504-0477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY108705174400000X
NY116929174400000X
NY150518174400000X
NY227230174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB12259Medicare UPIN
NYI53229Medicare UPIN
NYB79112Medicare UPIN
NYB12276Medicare UPIN