Basic Information
| Provider Information | |||||||||
| NPI: | 1780729111 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEARTCARE MEDICAL GROUP, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1303 209TH ST | ||||||||
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| City: | BAYSIDE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113601123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182794300 | ||||||||
| FaxNumber: | 7182047470 | ||||||||
| Practice Location | |||||||||
| Address1: | 5645 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | FLUSHING | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113555045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186701231 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | LOUDAROS | ||||||||
| AuthorizedOfficialFirstName: | EVA | ||||||||
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| AuthorizedOfficialTitleorPosition: | SERVICE REPRESENTATIVE | ||||||||
| AuthorizedOfficialTelephone: | 7182040414 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 152102 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 109798 | 01 | NY | DR. ARORA LICENSE # | OTHER | 152102 | 01 | NY | DR. MORDEN LICENSE# | OTHER | 00971857 | 05 | NY | MEDICAID | 00194954 | 05 | NY | MEDICAID |