Healthcare Provider Details

I. General information

NPI: 1063104701
Provider Name (Legal Business Name): ALPHA DIAGNOSTICS MANAGEMENT INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 WATERS PL STE 104
BRONX NY
10461-2729
US

IV. Provider business mailing address

1200 WATERS PL STE 104
BRONX NY
10461-2729
US

V. Phone/Fax

Practice location:
  • Phone: 888-929-7533
  • Fax: 888-929-7537
Mailing address:
  • Phone: 888-929-7533
  • Fax: 888-929-7537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173F00000X
TaxonomySleep Specialist (PhD)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DIMITRY KARGMAN
Title or Position: CEO
Credential:
Phone: 917-576-7467