Provider Demographics
NPI:1205983491
Name:NEW LIFE CARDIOVASCULAR CARE, P.C.
Entity type:Organization
Organization Name:NEW LIFE CARDIOVASCULAR CARE, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:MILBOURNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-966-1546
Mailing Address - Street 1:805 E WILLOW GROVE AVE # 19038
Mailing Address - Street 2:
Mailing Address - City:WYNDMOOR
Mailing Address - State:PA
Mailing Address - Zip Code:19038-7968
Mailing Address - Country:US
Mailing Address - Phone:215-966-1546
Mailing Address - Fax:215-764-5472
Practice Address - Street 1:805 E WILLOW GROVE AVE # 19038
Practice Address - Street 2:
Practice Address - City:GLENSIDE
Practice Address - State:PA
Practice Address - Zip Code:19038-7968
Practice Address - Country:US
Practice Address - Phone:215-966-1546
Practice Address - Fax:215-764-5472
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW LIFE CARDIOVASCULAR CARE ,PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-03
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA104746Medicare ID - Type Unspecified
PAF93932Medicare UPIN