Healthcare Provider Details

I. General information

NPI: 1376902148
Provider Name (Legal Business Name): BRMI @ MIDWOOD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2016
Last Update Date: 03/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 CONEY ISLAND AVE
BROOKLYN NY
11223-2328
US

IV. Provider business mailing address

7601 4TH AVE
BROOKLYN NY
11209-3207
US

V. Phone/Fax

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

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 Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

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