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General NPI Number Information
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NPI Number | 1558960690
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Entity Type | Organization
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Legal Business Name | NEW YORK MEDICAL DIAGNOSTIC IMAGING PC
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Dates
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Enumeration Date | 10/20/2020
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Last Update Date | 10/20/2020
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Provider Practice Location Address
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Address Line | 13617 39TH AVE STE 1D
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City | FLUSHING
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State | NY
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Zip | 11354-5504
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Country | US
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Telephone | 718-353-8988
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Fax | 718-285-7568
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Provider Business Mailing Address
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Address Line | 295 NORTHERN BLVD STE 307
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City | GREAT NECK
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State | NY
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Zip | 11021-4701
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Country | US
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Telephone | 516-482-7775
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Fax | 718-907-7910
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Authorized Official
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Title or Position | DIRECTOR
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Name | MISS DANIEL SHIFTEH
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Credential | MD
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Telephone | 718-353-8988
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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