Provider Demographics
NPI:1225195001
Name:LAWRENCE CARDIOVASCULAR ASSOCIATES PC
Entity type:Organization
Organization Name:LAWRENCE CARDIOVASCULAR ASSOCIATES PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-239-1616
Mailing Address - Street 1:135 ROCKAWAY TPKE STE 103
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-1023
Mailing Address - Country:US
Mailing Address - Phone:516-239-1616
Mailing Address - Fax:516-239-2566
Practice Address - Street 1:135 ROCKAWAY TPKE STE 103
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559-1023
Practice Address - Country:US
Practice Address - Phone:516-239-1616
Practice Address - Fax:516-239-1616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY135196207RC0000X
NY171383207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02468AMedicare PIN
NYW16591Medicare PIN