Healthcare Provider Details

I. General information

NPI: 1154944429
Provider Name (Legal Business Name): PDI HEALTH VT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2020
Last Update Date: 05/21/2020
Certification Date: 05/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 PINE HAVEN SHORES RD
SHELBURNE VT
05482-7703
US

IV. Provider business mailing address

12 SPENCER ST
BROOKLYN NY
11205-1891
US

V. Phone/Fax

Practice location:
  • Phone: 800-759-9729
  • Fax:
Mailing address:
  • Phone: 800-749-9729
  • 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: MENACHEM TAUBER
Title or Position: CEO
Credential:
Phone: 800-749-9729