Provider Demographics
NPI:1124066295
Name:ST. LAWRENCE CARDIOLOGY
Entity type:Organization
Organization Name:ST. LAWRENCE CARDIOLOGY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDRU
Authorized Official - Middle Name:B
Authorized Official - Last Name:STOIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-265-3072
Mailing Address - Street 1:PO BOX 5080
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-5080
Mailing Address - Country:US
Mailing Address - Phone:315-261-5920
Mailing Address - Fax:315-265-0878
Practice Address - Street 1:50 LEROY ST
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-1786
Practice Address - Country:US
Practice Address - Phone:315-261-5920
Practice Address - Fax:315-265-0878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY161770207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01019429Medicaid
NYDD0013Medicare ID - Type Unspecified
NY01019429Medicaid