Provider Demographics
NPI:1811939507
Name:CARDIOVASCULAR CONSULTANTS OF STATEN ISLAND PC
Entity type:Organization
Organization Name:CARDIOVASCULAR CONSULTANTS OF STATEN ISLAND PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISANTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MILLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PERSICHETTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-981-2864
Mailing Address - Street 1:11 RALPH PL
Mailing Address - Street 2:SUITE 109
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-4419
Mailing Address - Country:US
Mailing Address - Phone:718-981-2864
Mailing Address - Fax:718-981-5003
Practice Address - Street 1:11 RALPH PL
Practice Address - Street 2:SUITE 109
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-4419
Practice Address - Country:US
Practice Address - Phone:718-981-2864
Practice Address - Fax:718-981-5003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty