1558960690 NPI number — NEW YORK MEDICAL DIAGNOSTIC IMAGING PC

Table of content: (NPI 1558960690)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558960690 NPI number — NEW YORK MEDICAL DIAGNOSTIC IMAGING PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW YORK MEDICAL DIAGNOSTIC IMAGING PC
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:
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:
1558960690
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
295 NORTHERN BLVD STE 307
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREAT NECK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11021-4701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-482-7775
Provider Business Mailing Address Fax Number:
718-907-7910

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13617 39TH AVE STE 1D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLUSHING
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11354-5504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-353-8988
Provider Business Practice Location Address Fax Number:
718-285-7568
Provider Enumeration Date:
10/20/2020

Additional Information

Authorized Official

Authorized Official Last Name:
SHIFTEH
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
718-353-8988

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)





Copyright © 2007-2025 www.npivalidator.com