Healthcare Provider Details

I. General information

NPI: 1689231235
Provider Name (Legal Business Name): MIDTOWN DIAGNOSTIC GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2019
Last Update Date: 05/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 W 48TH ST STE 450
NEW YORK NY
10036-1324
US

IV. Provider business mailing address

353 W 48TH ST STE 450
NEW YORK NY
10036-1324
US

V. Phone/Fax

Practice location:
  • Phone: 212-389-9935
  • Fax: 212-389-9992
Mailing address:
  • Phone: 212-389-9935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: TAMMY CARPENTER
Title or Position: OFFICE MANAGER
Credential:
Phone: 212-389-9935