Healthcare Provider Details

I. General information

NPI: 1912291162
Provider Name (Legal Business Name): MZ RADIOLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2011
Last Update Date: 06/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PARK AVE S SUITE 1103
NEW YORK NY
10003-1503
US

IV. Provider business mailing address

200 PARK AVE S SUITE 1103
NEW YORK NY
10003-1503
US

V. Phone/Fax

Practice location:
  • Phone: 212-674-0444
  • Fax: 212-477-4163
Mailing address:
  • Phone: 212-674-0444
  • Fax: 212-477-4163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: DR. ZOYA MAKUMOVA, M.D, PH.D MAKUMOVA
Title or Position: DIRECTOR
Credential: M.D., PH.D.
Phone: 212-264-0444