Provider Demographics
NPI:1821065590
Name:NEW YORK CARDIOVASCULAR ASSOCIATES PLLC
Entity Type:Organization
Organization Name:NEW YORK CARDIOVASCULAR ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:PEG
Authorized Official - Middle Name:C
Authorized Official - Last Name:ELMQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-778-3454
Mailing Address - Street 1:275 7TH AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001
Mailing Address - Country:US
Mailing Address - Phone:646-660-9999
Mailing Address - Fax:646-778-3454
Practice Address - Street 1:275 7TH AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001
Practice Address - Country:US
Practice Address - Phone:646-660-9999
Practice Address - Fax:646-778-3450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-02
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RC0000X, 207RP1001X
NY207RS0012X, 207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02654153Medicaid
WEN871Medicare ID - Type Unspecified
NY02654153Medicaid