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General NPI Number Information
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NPI Number | 1356987473
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Entity Type | Organization
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Legal Business Name | MOSAIC DIAGNOSTIC IMAGING PLLC
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Dates
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Enumeration Date | 11/25/2019
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Last Update Date | 07/14/2021
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Provider Practice Location Address
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Address Line | 165 N VILLAGE AVE
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City | ROCKVILLE CENTRE
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State | NY
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Zip | 11570-3761
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Country | US
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Telephone | 631-793-8267
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Fax |
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Provider Business Mailing Address
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Address Line | 14 GEORGETOWN PL
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City | SMITHTOWN
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State | NY
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Zip | 11787-4912
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Country | US
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Telephone | 631-793-8267
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ERIC JAMES FELDMANN
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Credential | MD
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Telephone | 631-793-8267
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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 |
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License Number State |
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