Organization
BUSTLETON HEALTHCARE
Active
Parent organization
CARDIOLOGY CONSULTANTS OF GREATER PHILADELPHIA PC
Organization subpart
Yes
Provider details
NPI number
Legal business name
CARDIOLOGY CONSULTANTS OF GREATER PHILADELPHIA PC
Authorized official
IRINA JOUKOVA (PRESIDENT)
(267) 307-9236
Entity
Organization
Contact information
Practice address
9867 BUSTLETON AVE, SUITE B, PHILADELPHIA, PA 19115-2611
(215) 698-9295
Mailing address
9867 BUSTLETON AVE, SUITE B, PHILADELPHIA, PA 19115-2611
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
MD 435017
PA
261QP2300X
Primary Care Clinic/Center
Primary
MD 435017
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102790572 0001
—
PA
Enumeration date
11/22/2016
Last updated
11/22/2016
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