Healthcare Provider Details

I. General information

NPI: 1205111788
Provider Name (Legal Business Name): CELESTIAL SONO, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2011
Last Update Date: 10/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10811A 66TH AVE
FOREST HILLS NY
11375-2247
US

IV. Provider business mailing address

10811A 66TH AVE
FOREST HILLS NY
11375-2247
US

V. Phone/Fax

Practice location:
  • Phone: 718-459-3324
  • Fax:
Mailing address:
  • Phone: 718-459-3324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number39538
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number39538
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number39538
License Number State

VIII. Authorized Official

Name: MRS. SUSANA GUTMAN
Title or Position: PRESIDENT
Credential: RDMS,RDCS,RVT
Phone: 718-459-3324