Healthcare Provider Details

I. General information

NPI: 1376814863
Provider Name (Legal Business Name): APOLLO MEDICAL DIAGNOSTIC SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2012
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4036 74TH ST
ELMHURST NY
11373-5630
US

IV. Provider business mailing address

4036 74TH ST
ELMHURST NY
11373-5630
US

V. Phone/Fax

Practice location:
  • Phone: 718-426-6600
  • Fax: 718-374-5348
Mailing address:
  • Phone: 516-712-5542
  • Fax: 848-289-0805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: NAIYER IMAM
Title or Position: OWNER PRESIDENT
Credential: MD
Phone: 540-529-5472