MEDICARE: BROOKLYN NUCLEAR SPECT IMAGING, PC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207R00000X	Internal Medicine Physician
2	207UN0901X	Nuclear Cardiology Physician
3	207RC0000X	Cardiovascular Disease Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518912096
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOKLYN NUCLEAR SPECT IMAGING, PC

Provider Business Mailing Address
First Line	:	1435 86TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11228-3403
Country	:	US
Telephone Number	:	718-837-0010
Fax Number	:	718-837-1411

Provider Business Practice Location Address
First Line	:	1435 86TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11228-3403
Country	:	US
Telephone Number	:	718-837-0010
Fax Number	:	718-837-1411

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. ROBERT A VACCARINO
Credential	:	M.D.
Telephone Number	:	718-837-0010

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	01/04/2013

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