Provider Demographics
NPI:1194776518
Name:RAYTEL CARDIAC SERVICES, INC.
Entity type:Organization
Organization Name:RAYTEL CARDIAC SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:SASS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:860-298-6100
Mailing Address - Street 1:PO BOX 727
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-0727
Mailing Address - Country:US
Mailing Address - Phone:800-367-1095
Mailing Address - Fax:860-602-4749
Practice Address - Street 1:1979 MARCUS AVENUE
Practice Address - Street 2:SUITE C101
Practice Address - City:LAKE SUCCESS
Practice Address - State:NY
Practice Address - Zip Code:11042
Practice Address - Country:US
Practice Address - Phone:800-367-0300
Practice Address - Fax:877-639-9587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY97Z671Medicare PIN