Healthcare Provider Details

I. General information

NPI: 1316457518
Provider Name (Legal Business Name): AB MEDICAL DIAGNOSTICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2017
Last Update Date: 10/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

499 CHESTNUT ST STE 216
CEDARHURST NY
11516-2242
US

IV. Provider business mailing address

499 CHESTNUT ST STE 216
CEDARHURST NY
11516-2242
US

V. Phone/Fax

Practice location:
  • Phone: 516-268-5505
  • Fax: 516-232-8150
Mailing address:
  • Phone: 516-268-5505
  • Fax: 516-332-8150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number105427
License Number StateNY

VIII. Authorized Official

Name: DR. ALEX HARRY BRUCKSTEIN
Title or Position: MD/PRESIDENT
Credential: MD
Phone: 516-268-5505