Healthcare Provider Details

I. General information

NPI: 1235566449
Provider Name (Legal Business Name): PRO ULTRASOUND SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2013
Last Update Date: 10/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 DIVISION ST SUITE 2C
NEW YORK NY
10002-6714
US

IV. Provider business mailing address

39 DIVISION ST SUITE 2C
NEW YORK NY
10002-6714
US

V. Phone/Fax

Practice location:
  • Phone: 718-849-8331
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: R A
Title or Position: MANAGER
Credential:
Phone: 718-849-8331