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General NPI Number Information
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NPI Number | 1255695078
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Entity Type | Organization
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Legal Business Name | NORTH SHORE MEDICAL DIAGNOSTIC PC
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Dates
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Enumeration Date | 06/26/2012
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Last Update Date | 06/26/2012
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Provider Practice Location Address
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Address Line | 3044 CONEY ISLAND AVE 2ND FLOOR
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City | BROOKLYN
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State | NY
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Zip | 11235-5660
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Country | US
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Telephone | 718-934-1400
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Fax | 718-934-1440
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Provider Business Mailing Address
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Address Line | 1024 PENINSULA BLVD
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City | WOODMERE
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State | NY
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Zip | 11598-1542
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. IFFAT SADIQUE
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Credential | M.D
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Telephone | 646-462-9015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | 230830
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License Number State | NY
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