1295788917 NPI number — EAST MANHATTAN DIAGNOSTIC IMAGING, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295788917 NPI number — EAST MANHATTAN DIAGNOSTIC IMAGING, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST MANHATTAN DIAGNOSTIC IMAGING, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295788917
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10270
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UNIONDALE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11555-0270
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-830-3122
Provider Business Mailing Address Fax Number:
201-200-0838

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3131 KINGS HWY
Provider Second Line Business Practice Location Address:
SUITE A-4
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11234-2644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-758-1500
Provider Business Practice Location Address Fax Number:
718-758-2400
Provider Enumeration Date:
05/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MATH
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
201-830-3122

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 03234842 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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