Healthcare Provider Details

I. General information

NPI: 1992019400
Provider Name (Legal Business Name): PRO IMAGING SERVICES CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 07/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2108 W 7TH ST SUITE D
BROOKLYN NY
11223-3754
US

IV. Provider business mailing address

2108 W 7TH ST SUITE D
BROOKLYN NY
11223-3754
US

V. Phone/Fax

Practice location:
  • Phone: 347-492-3500
  • Fax: 347-492-3499
Mailing address:
  • Phone: 347-492-3500
  • Fax: 347-492-3499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KRISTINA MIRBABAYEVA
Title or Position: PRESIDENT
Credential:
Phone: 347-492-3500