Healthcare Provider Details

I. General information

NPI: 1053564781
Provider Name (Legal Business Name): NEW YORK PET IMAGING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 02/13/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7404 5TH AVE
BROOKLYN NY
11209-2704
US

IV. Provider business mailing address

7404 5TH AVE STE LL
BROOKLYN NY
11209-2704
US

V. Phone/Fax

Practice location:
  • Phone: 718-439-5111
  • Fax: 866-790-3506
Mailing address:
  • Phone: 718-439-5111
  • Fax: 866-790-3506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberH98121487078
License Number StateNY

VIII. Authorized Official

Name: DR. NIRANJAN K MITTAL
Title or Position: OWNER
Credential: MD
Phone: 718-439-5111