Healthcare Provider Details

I. General information

NPI: 1952447583
Provider Name (Legal Business Name): BROOKLYN NUCLEAR SPECT IMAGING, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 08/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8616 JAMAICA AVE
WOODHAVEN NY
11421-2042
US

IV. Provider business mailing address

8616 JAMAICA AVE
WOODHAVEN NY
11421-2042
US

V. Phone/Fax

Practice location:
  • Phone: 718-837-0010
  • Fax:
Mailing address:
  • Phone: 718-837-0010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT A VACCARINO
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 800-992-6827