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General NPI Number Information
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NPI Number | 1396913356
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Entity Type | Organization
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Legal Business Name | SCINTILLA IMAGING INC
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Dates
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Enumeration Date | 02/13/2008
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Last Update Date | 02/13/2008
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Provider Practice Location Address
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Address Line | 49 02 QUEENS BLVD
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City | WOODSIDE
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State | NY
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Zip | 11377
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Country | US
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Telephone | 347-249-0768
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Fax |
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Provider Business Mailing Address
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Address Line | 88 60 62ND DRIVE
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City | REGO PARK
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State | NY
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Zip | 11374
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Country | US
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Telephone | 347-247-0768
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Fax |
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Authorized Official
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Title or Position | DOTOR
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Name | ROBERT NEKRICH
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Credential | M.D
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Telephone | 347-249-0768
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085N0904X
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Taxonomy Name | Nuclear Radiology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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