Healthcare Provider Details

I. General information

NPI: 1346678497
Provider Name (Legal Business Name): MAGNIFIQUE ULTRASOUND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2013
Last Update Date: 03/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WYCHAM PL
GREAT NECK NY
11021-2518
US

IV. Provider business mailing address

1 WYCHAM PL
GREAT NECK NY
11021-2518
US

V. Phone/Fax

Practice location:
  • Phone: 516-487-3519
  • Fax: 516-487-3811
Mailing address:
  • Phone: 516-487-3519
  • Fax: 516-487-3811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code246W00000X
TaxonomyCardiology Technician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. AFSHIN SABZEHROO
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 516-487-3519