Provider Demographics
NPI:1851042568
Name:CITY HEART VASCULAR PLLC
Entity Type:Organization
Organization Name:CITY HEART VASCULAR PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SRINIVAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KESANAKURTHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-581-8093
Mailing Address - Street 1:12508 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11419-2234
Mailing Address - Country:US
Mailing Address - Phone:718-581-8093
Mailing Address - Fax:929-990-2928
Practice Address - Street 1:12508 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:SOUTH RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419-2234
Practice Address - Country:US
Practice Address - Phone:718-581-8093
Practice Address - Fax:929-990-2928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty