Provider Demographics
NPI:1023356144
Name:CARDIOLOGY CONSULTANTS OF GREATER PHILADELPHIA PC
Entity type:Organization
Organization Name:CARDIOLOGY CONSULTANTS OF GREATER PHILADELPHIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:JOUKOVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:267-307-9236
Mailing Address - Street 1:1420 LOCUST ST
Mailing Address - Street 2:APT. 23P
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-4223
Mailing Address - Country:US
Mailing Address - Phone:267-307-9236
Mailing Address - Fax:
Practice Address - Street 1:10752 BUSTLETON AVE
Practice Address - Street 2:SUITE G
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-3367
Practice Address - Country:US
Practice Address - Phone:267-307-9236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-24
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD435017207R00000X, 207RC0000X
NJ25MA08508800207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102431691 0001Medicaid
PA2157185Medicare PIN