Healthcare Provider Details

I. General information

NPI: 1114728185
Provider Name (Legal Business Name): APOLLO DIAGNOSTIC GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 NEW KARNER RD
ALBANY NY
12205-4627
US

IV. Provider business mailing address

251 NEW KARNER RD
ALBANY NY
12205-4627
US

V. Phone/Fax

Practice location:
  • Phone: 518-960-3143
  • Fax:
Mailing address:
  • Phone: 518-960-3143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: BRAD GOLDSTEIN
Title or Position: MANAGER
Credential:
Phone: 561-901-0764