Healthcare Provider Details

I. General information

NPI: 1558313593
Provider Name (Legal Business Name): EAST MANHATTAN DIAGNOSTIC IMAGING, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 12/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 2ND AVE
NEW YORK NY
10016-4859
US

IV. Provider business mailing address

PO BOX 10270
UNIONDALE NY
11555-0270
US

V. Phone/Fax

Practice location:
  • Phone: 212-683-6200
  • Fax: 212-683-2992
Mailing address:
  • Phone: 201-830-3122
  • Fax: 201-200-0838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: KEVIN MATH
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 201-830-3122