Healthcare Provider Details

I. General information

NPI: 1841598430
Provider Name (Legal Business Name): INNOVATIVE MEDICAL DIAGNOSTIC CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2011
Last Update Date: 03/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 MADISON AVE
NEW YORK NY
10035-3829
US

IV. Provider business mailing address

22 MERIDIAN RD STE 2
EDISON NJ
08820-2860
US

V. Phone/Fax

Practice location:
  • Phone: 212-860-3500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SATISH CHANDRA
Title or Position: PRESIDENT
Credential: MD
Phone: 732-321-1100