Healthcare Provider Details

I. General information

NPI: 1104357896
Provider Name (Legal Business Name): PARAMOUNT DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2017
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 IRVING PL
WOODMERE NY
11598-1639
US

IV. Provider business mailing address

201 IRVING PL
WOODMERE NY
11598-1639
US

V. Phone/Fax

Practice location:
  • Phone: 516-268-5505
  • Fax:
Mailing address:
  • Phone: 516-268-5505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: JEREMY GELBER
Title or Position: MANAGER
Credential:
Phone: 516-268-5505