MEDICARE: PROFESSIONAL HEALTH IMAGING,P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	200451	NY

General Provider Information

NPI Number	:	1508963547
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL HEALTH IMAGING,P.C.

Provider Business Mailing Address
First Line	:	3802 14TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-3610
Country	:	US
Telephone Number	:	718-854-5400
Fax Number	:

Provider Business Practice Location Address
First Line	:	3802 14TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-3610
Country	:	US
Telephone Number	:	718-854-5400
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. STEWART BAKST
Credential	:	M.D
Telephone Number	:	718-854-5400

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	12/07/2010

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