Healthcare Provider Details

I. General information

NPI: 1578220661
Provider Name (Legal Business Name): IMAGING & INTERVENTIONAL ASSOCIATE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2021
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4545 CENTER BLVD APT 2413
LONG ISLAND CITY NY
11109-5950
US

IV. Provider business mailing address

4545 CENTER BLVD APT 2413
LONG ISLAND CITY NY
11109-5950
US

V. Phone/Fax

Practice location:
  • Phone: 917-336-8422
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: IFTIKHAR AHMAD
Title or Position: OWNER
Credential: MD
Phone: 917-336-8422