Provider Demographics
NPI:1245362466
Name:INTERVENTIONAL CARDIOVASCULAR ASSOCIATES PLLC
Entity type:Organization
Organization Name:INTERVENTIONAL CARDIOVASCULAR ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:C
Authorized Official - Last Name:CARRIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-570-6909
Mailing Address - Street 1:100 PORT WASHINGTON BLVD
Mailing Address - Street 2:SUITE G03
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-1353
Mailing Address - Country:US
Mailing Address - Phone:516-365-6444
Mailing Address - Fax:516-365-6446
Practice Address - Street 1:100 PORT WASHINGTON BLVD
Practice Address - Street 2:SUITE G03
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-1353
Practice Address - Country:US
Practice Address - Phone:516-365-6444
Practice Address - Fax:516-365-6446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW35541Medicare ID - Type Unspecified