MEDICARE: WAVE IMAGING LLP

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	2085U0001X	Diagnostic Ultrasound Physician	126178	NY

General Provider Information

NPI Number	:	1598269037
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAVE IMAGING LLP

Provider Business Mailing Address
First Line	:	230 BEACH 102ND ST
Second Line	:
City	:	ROCKAWAY PARK
State	:	NY
Zip	:	11694-2861
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	230 BEACH 102ND ST STE 2B
Second Line	:
City	:	ROCKAWAY PARK
State	:	NY
Zip	:	11694-2871
Country	:	US
Telephone Number	:	347-302-2321
Fax Number	:

Authorized Official
Title or Position	:	ULTRASOUND TECHNOLOGIST
Name	:	MELISSA PARAISON
Credential	:	MPH, RDMS, CPC-A
Telephone Number	:	347-302-2321

Provider Enumeration Date	:	03/20/2018
Last Update Date	:	03/20/2018

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