Provider Demographics
NPI:1912912502
Name:LONG ISLAND CARDIOVASCULAR GROUP PC
Entity type:Organization
Organization Name:LONG ISLAND CARDIOVASCULAR GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:I
Authorized Official - Last Name:TARKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:516-569-5200
Mailing Address - Street 1:123 GROVE AVE
Mailing Address - Street 2:SUITE 216
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516
Mailing Address - Country:US
Mailing Address - Phone:516-569-5200
Mailing Address - Fax:516-569-7403
Practice Address - Street 1:123 GROVE AVE
Practice Address - Street 2:SUITE 216
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516
Practice Address - Country:US
Practice Address - Phone:516-569-5200
Practice Address - Fax:516-569-7403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW19221Medicare PIN
1912912502Medicare NSC