Organization
PECONIC CARDIOLOGY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MICHELE LEE CUSACK (SENIOR VICE PRESIDENT & CFO)
(516) 321-6058
Entity
Organization
Contact information
Practice address
951 ROANOKE AVE, RIVERHEAD, NY 11901-2724
(631) 727-7773
(631) 727-7832
Mailing address
951 ROANOKE AVE, RIVERHEAD, NY 11901-2724
(631) 727-7773
(631) 727-7832
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
207UN0901X
Nuclear Cardiology Physician
—
—
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
—
—
Other
Enumeration date
08/13/2018
Last updated
07/08/2022
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