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

Table of content: (NPI 1295788917)

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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