Healthcare Provider Details

I. General information

NPI: 1366067787
Provider Name (Legal Business Name): PDI HEALTH MA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2020
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BRIDGE ST
NEWTON MA
02458-1132
US

IV. Provider business mailing address

12 SPENCER ST
BROOKLYN NY
11205-1891
US

V. Phone/Fax

Practice location:
  • Phone: 800-749-9729
  • Fax:
Mailing address:
  • Phone: 800-749-9729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
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: 800-749-9729