Provider Demographics
NPI:1235142407
Name:CARDIOVASCULAR IMAGING OF BROOKLYN, PC
Entity type:Organization
Organization Name:CARDIOVASCULAR IMAGING OF BROOKLYN, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:VACCARINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-644-0002
Mailing Address - Street 1:150 E 61ST ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-8529
Mailing Address - Country:US
Mailing Address - Phone:212-644-0002
Mailing Address - Fax:212-644-1404
Practice Address - Street 1:150 E 61ST ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-8529
Practice Address - Country:US
Practice Address - Phone:212-644-0002
Practice Address - Fax:212-644-1404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Not Answered207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW17153Medicare ID - Type UnspecifiedGROUP MEDICARE