Healthcare Provider Details

I. General information

NPI: 1750465522
Provider Name (Legal Business Name): MEDSPECT NUCLEAR IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9920 4TH AVE STE 209
BROOKLYN NY
11209-8330
US

IV. Provider business mailing address

9920 4TH AVE STE 209
BROOKLYN NY
11209-8330
US

V. Phone/Fax

Practice location:
  • Phone: 718-833-1300
  • Fax: 718-833-4852
Mailing address:
  • Phone: 718-833-1300
  • Fax: 718-833-4852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. MICKEY FELDMAN
Title or Position: MEDICAL ADMINISTRATOR
Credential: MBA
Phone: 718-833-1300