Provider Demographics
NPI:1457638702
Name:CARDIOCARE PC
Entity Type:Organization
Organization Name:CARDIOCARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ZAZA
Authorized Official - Middle Name:
Authorized Official - Last Name:AIVAZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:718-440-6161
Mailing Address - Street 1:777 ADDISON ST
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-2937
Mailing Address - Country:US
Mailing Address - Phone:718-440-6161
Mailing Address - Fax:
Practice Address - Street 1:128 BEACH 115TH ST
Practice Address - Street 2:
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694-2408
Practice Address - Country:US
Practice Address - Phone:718-474-6400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223734207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty