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General NPI Number Information
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NPI Number | 1306065453
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Entity Type | Organization
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Legal Business Name | ALLIANCE MEDICAL TECHNOLOGY
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3 THE GRASSLANDS
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City | WOODBURY
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State | NY
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Zip | 11797-1118
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Country | US
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Telephone | 718-445-5458
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Fax | 718-939-3462
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Provider Business Mailing Address
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Address Line | PO BOX 305
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City | WOODBURY
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State | NY
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Zip | 11797-0305
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Country | US
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Telephone | 718-445-5458
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Fax | 718-939-3462
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Authorized Official
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Title or Position | OWNER
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Name | DR. MITCHELL ALAN COHN
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Credential | M.D.
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Telephone | 718-445-5458
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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 | 170790
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License Number State | NY
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