Healthcare Provider Details

I. General information

NPI: 1124624713
Provider Name (Legal Business Name): ACCUMEDIC DIAGNOSTIC MGNT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2020
Last Update Date: 11/03/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E ATLANTIC BLVD STE 204
POMPANO BEACH FL
33060-7427
US

IV. Provider business mailing address

1000 EAST ATLANTIC BLVD SUITE 204
POMPANO BEACH FL
33060
US

V. Phone/Fax

Practice location:
  • Phone: 844-954-2228
  • Fax:
Mailing address:
  • Phone: 844-954-2228
  • Fax: 754-206-6228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. EMAN DESIR
Title or Position: PRESIDENT
Credential:
Phone: 347-754-7449