Healthcare Provider Details

I. General information

NPI: 1336372671
Provider Name (Legal Business Name): BAY RIDGE MEDICAL IMAGING, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2009
Last Update Date: 09/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 AVENUE P
BROOKLYN NY
11229-1009
US

IV. Provider business mailing address

7601 4TH AVE
BROOKLYN NY
11209-3207
US

V. Phone/Fax

Practice location:
  • Phone: 718-375-1300
  • Fax: 718-238-7005
Mailing address:
  • Phone: 718-238-7000
  • Fax: 718-238-7005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ABIRI SHAHROKH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-238-7000