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General NPI Number Information
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NPI Number | 1023435971
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Entity Type | Organization
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Legal Business Name | MEDICAL DIAGNOSTIC IMAGING PLLC
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Dates
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Enumeration Date | 03/27/2014
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 1323 ROUTE 9
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City | WAPPINGERS FALLS
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State | NY
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Zip | 12590-4904
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Country | US
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Telephone | 845-471-2848
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Fax | 845-471-2919
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Provider Business Mailing Address
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Address Line | 14 RAYMOND AVE
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City | POUGHKEEPSIE
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State | NY
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Zip | 12603-2312
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Country | US
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Telephone | 845-471-2848
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Fax | 845-471-2919
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL WALDMAN
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Credential | MD
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Telephone | 203-818-1165
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 186503
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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