Healthcare Provider Details

I. General information

NPI: 1376842633
Provider Name (Legal Business Name): INNERVISIONSONOGRAPHY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2011
Last Update Date: 04/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4064 BRUNER AVE
BRONX NY
10466-2229
US

IV. Provider business mailing address

4064 BRUNER AVE
BRONX NY
10466-2229
US

V. Phone/Fax

Practice location:
  • Phone: 917-569-0027
  • Fax:
Mailing address:
  • Phone: 917-569-0027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number00072877
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number
License Number StateNY

VIII. Authorized Official

Name: MR. GEORGE MINIX
Title or Position: DIRECTOR OF OPERATIONS
Credential: RCS
Phone: 917-569-0027