Provider Demographics
NPI:1962584599
Name:INTERVENTIONAL CARDIAC CONSULTANTS, LLP
Entity type:Organization
Organization Name:INTERVENTIONAL CARDIAC CONSULTANTS, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRUNWALD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-358-5401
Mailing Address - Street 1:3003 NEW HYDE PARK RD
Mailing Address - Street 2:406
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1214
Mailing Address - Country:US
Mailing Address - Phone:516-358-5401
Mailing Address - Fax:516-358-5403
Practice Address - Street 1:3003 NEW HYDE PARK RD
Practice Address - Street 2:406
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1214
Practice Address - Country:US
Practice Address - Phone:516-358-5401
Practice Address - Fax:516-358-5403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02301251Medicaid
NY03877Medicare PIN
NY02301251Medicaid