Provider Demographics
NPI:1881765139
Name:BROADWAY CARDIOPULMONARY, P.C.
Entity type:Organization
Organization Name:BROADWAY CARDIOPULMONARY, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:FARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ATALLAH-LAJAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-407-3950
Mailing Address - Street 1:110 E 59TH ST
Mailing Address - Street 2:SUITE 10B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1304
Mailing Address - Country:US
Mailing Address - Phone:212-407-3950
Mailing Address - Fax:212-583-2961
Practice Address - Street 1:110 E 59TH ST
Practice Address - Street 2:SUITE 10B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1304
Practice Address - Country:US
Practice Address - Phone:212-407-3950
Practice Address - Fax:212-583-2961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60-22603207RC0000X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Not Answered207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Multi-Specialty