Provider Demographics
NPI:1992246953
Name:NORTHEAST CARDIOLOGY PLLC
Entity type:Organization
Organization Name:NORTHEAST CARDIOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NASIR
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDEZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-682-0448
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-0130
Mailing Address - Country:US
Mailing Address - Phone:606-682-0448
Mailing Address - Fax:
Practice Address - Street 1:1313 ST.ANTHONY PLACE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-0130
Practice Address - Country:US
Practice Address - Phone:606-682-0448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-10
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty