Healthcare Provider Details

I. General information

NPI: 1235999335
Provider Name (Legal Business Name): NEW DIAGNOSTIC IMAGING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2024
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608 59TH ST
BROOKLYN NY
11204-2129
US

IV. Provider business mailing address

1608 59TH ST
BROOKLYN NY
11204-2129
US

V. Phone/Fax

Practice location:
  • Phone: 929-265-5151
  • Fax: 718-874-0058
Mailing address:
  • Phone: 929-265-5151
  • Fax: 718-874-0058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AHMAD MASOUD
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 919-265-5151