Provider Demographics
NPI:1831498740
Name:CARDIOVASCULAR ASSOCIATES OF STATEN ISLAND LLC
Entity Type:Organization
Organization Name:CARDIOVASCULAR ASSOCIATES OF STATEN ISLAND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:K
Authorized Official - Last Name:O'BYRNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-667-0077
Mailing Address - Street 1:501 SEAVIEW AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-3419
Mailing Address - Country:US
Mailing Address - Phone:718-667-0077
Mailing Address - Fax:718-667-4103
Practice Address - Street 1:501 SEAVIEW AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3419
Practice Address - Country:US
Practice Address - Phone:718-667-0077
Practice Address - Fax:718-667-4103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-17
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194645207RC0000X
NY231108207RC0000X
NY216124207RC0000X
NY198311207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty