Healthcare Provider Details

I. General information

NPI: 1053587253
Provider Name (Legal Business Name): BROOKLYN NUCLEAR SPECT IMAGING PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 38TH ST FL 2
ASTORIA NY
11103-3804
US

IV. Provider business mailing address

1435 86TH ST
BROOKLYN NY
11228-3403
US

V. Phone/Fax

Practice location:
  • Phone: 718-545-2020
  • Fax:
Mailing address:
  • Phone: 718-837-0010
  • Fax: 718-837-9797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number170563-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number170563-1
License Number StateNY

VIII. Authorized Official

Name: DR. ROBERT ALDO VACCARINO
Title or Position: PRESIDENT
Credential: MD
Phone: 718-837-0010