Provider Demographics
NPI:1568830834
Name:CARDIOVASCULAR WELLNESS MEDICAL SERVICES PLLC
Entity type:Organization
Organization Name:CARDIOVASCULAR WELLNESS MEDICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRSAKOV
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:917-538-4132
Mailing Address - Street 1:8 W 38TH ST RM 503
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-6368
Mailing Address - Country:US
Mailing Address - Phone:212-730-7232
Mailing Address - Fax:212-687-0030
Practice Address - Street 1:8 W 38TH ST RM 503
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-6368
Practice Address - Country:US
Practice Address - Phone:212-730-7232
Practice Address - Fax:212-687-0030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-03
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty