Provider Demographics
NPI:1053563759
Name:CARDIOVASCULAR DIAGNOSTIC CARE OF NEW YORK P.C.
Entity type:Organization
Organization Name:CARDIOVASCULAR DIAGNOSTIC CARE OF NEW YORK P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CREDENTIALING
Authorized Official - Prefix:MS
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:
Authorized Official - Last Name:RESTIVO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-794-4161
Mailing Address - Street 1:248 BAYVILLE AVE
Mailing Address - Street 2:P.O. BOX 1357
Mailing Address - City:BAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11709-1616
Mailing Address - Country:US
Mailing Address - Phone:516-794-4161
Mailing Address - Fax:516-794-9568
Practice Address - Street 1:423 E 138TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10454-3041
Practice Address - Country:US
Practice Address - Phone:718-292-0100
Practice Address - Fax:347-591-3862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1225121174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY33A591Medicare PIN