Provider Demographics
NPI:1730258690
Name:NORTHSHORE CARDIO PULMONARY ASSOCIATES PC
Entity type:Organization
Organization Name:NORTHSHORE CARDIO PULMONARY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MALIAKAL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:ANTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-496-7900
Mailing Address - Street 1:8 GREENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791
Mailing Address - Country:US
Mailing Address - Phone:516-496-7900
Mailing Address - Fax:516-496-2139
Practice Address - Street 1:8 GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791
Practice Address - Country:US
Practice Address - Phone:516-496-7900
Practice Address - Fax:516-496-2139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW0Z051OtherMEDICARE ID-TYPE UNSPECIFIED
NYW0Z051Medicare PIN