Healthcare Provider Details

I. General information

NPI: 1427371756
Provider Name (Legal Business Name): CUTTING EDGE PET/CF AND IMAGING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2010
Last Update Date: 03/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93-95 WYCKOFF AVENUE
BROOKLYN NY
11237
US

IV. Provider business mailing address

PO BOX 370670
BROOKLYN NY
11237
US

V. Phone/Fax

Practice location:
  • Phone: 718-963-7381
  • Fax: 718-963-7744
Mailing address:
  • Phone: 718-963-7381
  • Fax: 718-963-7744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State

VIII. Authorized Official

Name: MOHSEN SAMIL
Title or Position: PHYSICIAN/PARTNER
Credential: MD.
Phone: 718-963-7230