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General NPI Number Information
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NPI Number | 1407113160
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Entity Type | Organization
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Legal Business Name | IMAGO MEDICAL DIAGNOSTICS P.C.
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Dates
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Enumeration Date | 04/19/2012
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Last Update Date | 04/19/2012
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Provider Practice Location Address
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Address Line | 2769 CONEY ISLAND AVE STE 2
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City | BROOKLYN
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State | NY
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Zip | 11235-5051
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Country | US
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Telephone | 914-589-1592
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Fax | 718-676-1305
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Provider Business Mailing Address
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Address Line | 2769 CONEY ISLAND AVE STE 2
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City | BROOKLYN
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State | NY
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Zip | 11235-5051
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Country | US
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Telephone | 314-589-1592
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Fax | 718-676-1305
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ERIC A LUBIN
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Credential | MD
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Telephone | 914-589-1592
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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 |
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License Number State |
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