Healthcare Provider Details

I. General information

NPI: 1790771889
Provider Name (Legal Business Name): NEW YORK MEDICAL & DIAGNOSTIC CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 05/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8046 KEW GARDENS RD
KEW GARDENS NY
11415-1154
US

IV. Provider business mailing address

8046 KEW GARDENS RD
KEW GARDENS NY
11415-1154
US

V. Phone/Fax

Practice location:
  • Phone: 718-261-1000
  • Fax: 718-261-0336
Mailing address:
  • Phone: 718-261-1000
  • Fax: 718-261-0336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JACOB K SADIGH
Title or Position: ADMINISTRATOR
Credential: D.C.
Phone: 718-261-1000