Healthcare Provider Details

I. General information

NPI: 1811927023
Provider Name (Legal Business Name): LONG ISLAND MEDICAL DIAGNOSTIC IMAGING, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 10/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

369 E MAIN ST SUITE 18
EAST ISLIP NY
11730-2800
US

IV. Provider business mailing address

369 E MAIN ST SUITE 18
EAST ISLIP NY
11730-2800
US

V. Phone/Fax

Practice location:
  • Phone: 631-277-1600
  • Fax: 631-277-1638
Mailing address:
  • Phone: 631-277-1600
  • Fax: 631-277-1638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALBERT ZILKHA
Title or Position: OWNER
Credential: MD
Phone: 631-277-1600