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General NPI Number Information
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NPI Number | 1578744785
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Entity Type | Organization
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Legal Business Name | AIM 4 LIFE MEDICAL DIAGNOSTICS PC
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Dates
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Enumeration Date | 11/15/2007
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Last Update Date | 11/15/2007
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Provider Practice Location Address
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Address Line | 6829 SPRINGFIELD BLVD
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City | BAYSIDE
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State | NY
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Zip | 11365
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Country | US
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Telephone | 718-279-0020
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Fax |
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Provider Business Mailing Address
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Address Line | 3820 208TH ST
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City | BAYSIDE
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State | NY
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Zip | 11361-1929
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Country | US
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Telephone | 718-279-0020
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | NODARI MIKHELASHVILI
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Credential | MD
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Telephone | 718-279-0020
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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 | 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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Taxonomy #3
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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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