Healthcare Provider Details

I. General information

NPI: 1891882585
Provider Name (Legal Business Name): CLEAR VIEW MRI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 HEMPSTEAD TPKE
EAST MEADOW NY
11554-1855
US

IV. Provider business mailing address

2160 HEMPSTEAD TPKE
EAST MEADOW NY
11554-1855
US

V. Phone/Fax

Practice location:
  • Phone: 516-222-2125
  • Fax: 516-222-2126
Mailing address:
  • Phone: 516-222-2125
  • Fax: 516-222-2126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number179224-1
License Number StateNY

VIII. Authorized Official

Name: MR. NICOLA A DIAZ I
Title or Position: CEO
Credential:
Phone: 516-222-2125