Provider Demographics
NPI:1720292543
Name:WSMC CARDIOLOGY PC
Entity Type:Organization
Organization Name:WSMC CARDIOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:N
Authorized Official - Last Name:KLESTZICK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:718-239-5877
Mailing Address - Street 1:PO BOX 297
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10804-0297
Mailing Address - Country:US
Mailing Address - Phone:718-239-5877
Mailing Address - Fax:718-239-6957
Practice Address - Street 1:2475 SAINT RAYMONDS AVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3124
Practice Address - Country:US
Practice Address - Phone:718-239-5877
Practice Address - Fax:718-239-6957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195483207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW13121Medicare UPIN