Provider Demographics
NPI:1942435136
Name:SMITHTOWN CARDIOVASCULAR RISK INTERVENTION PROGRAM
Entity Type:Organization
Organization Name:SMITHTOWN CARDIOVASCULAR RISK INTERVENTION PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:LOWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-427-1818
Mailing Address - Street 1:104 LA RUE DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2502
Mailing Address - Country:US
Mailing Address - Phone:631-427-1818
Mailing Address - Fax:631-427-2220
Practice Address - Street 1:104 LA RUE DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2502
Practice Address - Country:US
Practice Address - Phone:631-427-1818
Practice Address - Fax:631-427-2220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2046731174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty