Provider Demographics
NPI:1174807127
Name:INTEGRATIVE CARDIOLOGY PRACTICE, PLLC
Entity type:Organization
Organization Name:INTEGRATIVE CARDIOLOGY PRACTICE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-926-3384
Mailing Address - Street 1:7502 AUSTIN ST
Mailing Address - Street 2:#6A
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6237
Mailing Address - Country:US
Mailing Address - Phone:646-926-3384
Mailing Address - Fax:866-795-9603
Practice Address - Street 1:635 MADISON AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1009
Practice Address - Country:US
Practice Address - Phone:646-926-3384
Practice Address - Fax:866-795-9603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-07
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245042261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
1427368281OtherNPI - DDM MEDICAL, PC
NYA300046369OtherMEDICARE PTAN
1487827283OtherNPI INDIVIDUAL