Healthcare Provider Details

I. General information

NPI: 1972992055
Provider Name (Legal Business Name): INTELLIGENT MEDICAL DIAGNOSTICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2015
Last Update Date: 01/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1384 E 19TH ST SUITE 1
BROOKLYN NY
11230-6112
US

IV. Provider business mailing address

1384 E 19TH ST SUITE 1
BROOKLYN NY
11230-6112
US

V. Phone/Fax

Practice location:
  • Phone: 718-336-3005
  • Fax: 718-336-3006
Mailing address:
  • Phone: 718-336-3005
  • Fax: 718-336-3006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number219418
License Number StateNY

VIII. Authorized Official

Name: EUGENE SHTEERMAN
Title or Position: MEDICAL DOCTOR, OWNER
Credential: M.D.
Phone: 718-336-3005