Healthcare Provider Details

I. General information

NPI: 1083083927
Provider Name (Legal Business Name): NOA DIAGNOSTICS OF RI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2015
Last Update Date: 09/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6851 JERICHO TPKE SUITE 150
SYOSSET NY
11791-4494
US

IV. Provider business mailing address

6851 JERICHO TPKE SUITE 150
SYOSSET NY
11791-4494
US

V. Phone/Fax

Practice location:
  • Phone: 516-986-2700
  • Fax: 516-986-2710
Mailing address:
  • Phone: 516-986-2700
  • Fax: 516-986-2710

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: MR. EVAN JASSER
Title or Position: PRESIDENT
Credential:
Phone: 516-986-2700