Healthcare Provider Details

I. General information

NPI: 1780371740
Provider Name (Legal Business Name): MEDICAL ULTRASOUND READING PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2023
Last Update Date: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2560 OCEAN AVE
BROOKLYN NY
11229-4507
US

IV. Provider business mailing address

2560 OCEAN AVE
BROOKLYN NY
11229-4507
US

V. Phone/Fax

Practice location:
  • Phone: 718-615-4100
  • Fax: 718-615-9335
Mailing address:
  • Phone: 718-615-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: VADIM KOLSENIKOV
Title or Position: OWNER
Credential: MD
Phone: 718-615-4100