NPIMap

Organization Active NPI

Shore Road Cardiology Associates, PC

  • Cardiovascular Disease Physician
  • Brooklyn, NY
National Provider Identifier
1790791457
Registry record updated Sep 8, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
16885 Issued in NY
Legal business name
SHORE ROAD CARDIOLOGY ASSOCIATES, PC
Practice address
150 55TH St
Brooklyn, NY 11220-2559
Phone
(718) 630-7477
Fax
(718) 630-8515
NPI assigned
Aug 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Gary Dellacerra, V.P.
Title
VP Managed Care & Revenue Complianc
Phone
(718) 630-7103

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207RC0000X 16885 NY Primary
Clinical Cardiac Electrophysiology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207RC0001X 16885 NY
Interventional Cardiology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207RI0011X 16885 NY

Addresses

Primary practice location

150 55TH St
Brooklyn, NY 11220-2559

Mailing address

5800 3Rd Ave
Lutheran Medical Center-Managed Care Department
Brooklyn, NY 11220-3702
Phone (718) 630-7477

Other identifiers 1

IdentifierTypeStateIssuer
00820939MedicaidNY

National Provider Directory

National Provider Directory

Locations

150 55th St
Rm 2029
Brooklyn, NY 11220

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1220832000000",
    "number": "1790791457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5800 3RD AVE",
            "address_2": "LUTHERAN MEDICAL CENTER-MANAGED CARE DEPARTMENT",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112203702",
            "telephone_number": "718-630-7477",
            "fax_number": "718-630-7437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 55TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112202559",
            "telephone_number": "718-630-7477",
            "fax_number": "718-630-8515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHORE ROAD CARDIOLOGY ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-01",
        "last_updated": "2008-09-08",
        "status": "A",
        "authorized_official_last_name": "DELLACERRA",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "VP MANAGED CARE & REVENUE COMPLIANC",
        "authorized_official_telephone_number": "718-630-7103",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "V.P."
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NY",
            "license": "16885",
            "primary": true
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "NY",
            "license": "16885",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "NY",
            "license": "16885",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00820939",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.