Healthcare Provider Details

I. General information

NPI: 1740580604
Provider Name (Legal Business Name): 4220 ASSCOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2010
Last Update Date: 10/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2529 87TH ST
EAST ELMHURST NY
11369-1020
US

IV. Provider business mailing address

2529 87TH ST
EAST ELMHURST NY
11369-1020
US

V. Phone/Fax

Practice location:
  • Phone: 718-848-7142
  • Fax: 718-848-7153
Mailing address:
  • Phone: 718-848-7142
  • Fax: 718-848-7153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: POOJA PAREKH
Title or Position: OWNER
Credential:
Phone: 718-848-7142