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General NPI Number Information
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NPI Number | 1316457518
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Entity Type | Organization
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Legal Business Name | AB MEDICAL DIAGNOSTICS PC
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Dates
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Enumeration Date | 10/03/2017
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Last Update Date | 10/03/2017
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Provider Practice Location Address
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Address Line | 499 CHESTNUT ST STE 216
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City | CEDARHURST
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State | NY
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Zip | 11516-2242
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Country | US
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Telephone | 516-268-5505
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Fax | 516-232-8150
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Provider Business Mailing Address
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Address Line | 499 CHESTNUT ST STE 216
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City | CEDARHURST
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State | NY
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Zip | 11516-2242
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Country | US
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Telephone | 516-268-5505
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Fax | 516-332-8150
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Authorized Official
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Title or Position | MD/PRESIDENT
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Name | DR. ALEX HARRY BRUCKSTEIN
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Credential | MD
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Telephone | 516-268-5505
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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 | 105427
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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