Provider Demographics
NPI:1609984913
Name:ADVANCED CARDIAC MEDICINE PC
Entity type:Organization
Organization Name:ADVANCED CARDIAC MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAJEEV
Authorized Official - Middle Name:
Authorized Official - Last Name:SRIVASTAVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-297-8398
Mailing Address - Street 1:16215 HIGHLAND AVENUE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432
Mailing Address - Country:US
Mailing Address - Phone:718-297-8398
Mailing Address - Fax:718-297-0063
Practice Address - Street 1:16215 HIGHLAND AVENUE
Practice Address - Street 2:SUITE 1A
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432
Practice Address - Country:US
Practice Address - Phone:718-297-8398
Practice Address - Fax:718-297-0063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197800207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01947819Medicaid
G95423Medicare UPIN
NY01947819Medicaid