Provider Demographics
NPI:1750570628
Name:UTOPIA HEARTCARE PLLC
Entity type:Organization
Organization Name:UTOPIA HEARTCARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:URMILA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIVARAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-217-0500
Mailing Address - Street 1:21116 UNION TPKE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-3241
Mailing Address - Country:US
Mailing Address - Phone:718-217-0500
Mailing Address - Fax:718-217-0533
Practice Address - Street 1:21116 UNION TPKE
Practice Address - Street 2:
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-3241
Practice Address - Country:US
Practice Address - Phone:718-217-0500
Practice Address - Fax:718-217-0533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160413174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00947219Medicaid
NY00947219Medicaid