Organization
SHORE ROAD CARDIOLOGY ASSOCIATES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY DELLACERRA V.P. (VP MANAGED CARE & REVENUE COMPLIANC)
(718) 630-7103
Entity
Organization
Contact information
Practice address
150 55TH ST, BROOKLYN, NY 11220-2559
(718) 630-7477
(718) 630-8515
Mailing address
5800 3RD AVE, LUTHERAN MEDICAL CENTER-MANAGED CARE DEPARTMENT, BROOKLYN, NY 11220-3702
(718) 630-7477
(718) 630-7437
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
16885
NY
207RC0001X
Clinical Cardiac Electrophysiology Physician
16885
NY
207RI0011X
Interventional Cardiology Physician
16885
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00820939
—
NY
Enumeration date
08/01/2006
Last updated
09/08/2008
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