Healthcare Provider Details

I. General information

NPI: 1437324712
Provider Name (Legal Business Name): METROPOLITAN DIAGNOSTIC IMAGING, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NORTHERN BLVD STE. 115
GREAT NECK NY
11021-5200
US

IV. Provider business mailing address

600 NORTHERN BLVD STE. 115
GREAT NECK NY
11021-5200
US

V. Phone/Fax

Practice location:
  • Phone: 516-482-8220
  • Fax: 516-482-8221
Mailing address:
  • Phone: 516-482-8220
  • Fax: 516-482-8221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ANDREW WINAKOR
Title or Position: DIRECTOR, MANAGED CARE
Credential:
Phone: 516-616-5000