Provider Demographics
NPI:1013928266
Name:CARDIAC SURGERY GROUP, PC
Entity Type:Organization
Organization Name:CARDIAC SURGERY GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUDEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-493-8665
Mailing Address - Street 1:PO BOX 434
Mailing Address - Street 2:
Mailing Address - City:ELMSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:10523-0434
Mailing Address - Country:US
Mailing Address - Phone:914-493-8665
Mailing Address - Fax:914-493-1793
Practice Address - Street 1:WESTCHESTER MEDICAL CENTER
Practice Address - Street 2:95 GRASSLANDS RD, MACY PAVILION ROOM W128
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595
Practice Address - Country:US
Practice Address - Phone:914-493-7676
Practice Address - Fax:914-493-1793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W17371Medicare ID - Type Unspecified