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General NPI Number Information
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NPI Number | 1548817307
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Entity Type | Organization
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Legal Business Name | SANDY DIMANCHE
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Dates
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Enumeration Date | 08/26/2019
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Last Update Date | 10/04/2019
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Provider Practice Location Address
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Address Line | 11326 202ND ST
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City | SAINT ALBANS
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State | NY
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Zip | 11412-2531
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Country | US
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Telephone | 201-397-0496
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Fax |
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Provider Business Mailing Address
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Address Line | 11326 202ND ST
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City | SAINT ALBANS
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State | NY
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Zip | 11412-2531
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Country | US
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Telephone | 201-397-0496
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SANDY DIMANCHE
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Credential | RDMS. RDCS, RVT
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Telephone | 201-397-0496
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0208X
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Taxonomy Name | Mobile Radiology Clinic/Center
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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 | 335V00000X
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Taxonomy Name | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
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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 | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number |
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License Number State |
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