Provider Demographics
NPI:1851594956
Name:NEW YORK CARDIOVASCULAR SPECIALIST PC
Entity Type:Organization
Organization Name:NEW YORK CARDIOVASCULAR SPECIALIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HENOCK
Authorized Official - Middle Name:
Authorized Official - Last Name:SAINT-JACQUES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-462-2090
Mailing Address - Street 1:PO BOX 1170
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-0825
Mailing Address - Country:US
Mailing Address - Phone:212-348-9400
Mailing Address - Fax:212-348-9405
Practice Address - Street 1:1787 MADISON AVE
Practice Address - Street 2:SUITE 50C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-4518
Practice Address - Country:US
Practice Address - Phone:212-348-9400
Practice Address - Fax:212-348-9405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219132207RC0000X, 207RI0011X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWWR671Medicare PIN