Healthcare Provider Details

I. General information

NPI: 1568665818
Provider Name (Legal Business Name): BIMC FACULTY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 08/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 UNION SQ E SUITE 3P
NEW YORK NY
10003-3314
US

IV. Provider business mailing address

1780 BROADWAY STE 300
NEW YORK NY
10019-1414
US

V. Phone/Fax

Practice location:
  • Phone: 212-590-2922
  • Fax: 212-590-2977
Mailing address:
  • Phone: 212-590-2922
  • Fax: 212-590-2977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL ABIRI
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 212-590-5922