Provider Demographics
NPI:1700083235
Name:CLINICAL AND INTERVENTIONAL CARDIOLOGY PLLC
Entity type:Organization
Organization Name:CLINICAL AND INTERVENTIONAL CARDIOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:V
Authorized Official - Last Name:PERRY-BOTTINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-576-7577
Mailing Address - Street 1:140A LOCKWOOD AVENUE
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801
Mailing Address - Country:US
Mailing Address - Phone:914-576-7577
Mailing Address - Fax:914-576-7377
Practice Address - Street 1:140A LOCKWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-4920
Practice Address - Country:US
Practice Address - Phone:914-576-7577
Practice Address - Fax:914-576-7377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2066371207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01741120Medicaid
NYE94409Medicare UPIN
NY01741120Medicaid