Healthcare Provider Details

I. General information

NPI: 1215795844
Provider Name (Legal Business Name): PDI HEALTH AR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2024
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 ROGERS AVE
FORT SMITH AR
72901-1904
US

IV. Provider business mailing address

12 SPENCER ST STE 2
BROOKLYN NY
11205-1892
US

V. Phone/Fax

Practice location:
  • Phone: 646-924-7211
  • Fax:
Mailing address:
  • Phone: 646-924-7211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: MENACHEM TAUBER
Title or Position: CEO
Credential:
Phone: 646-924-7211