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General NPI Number Information
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NPI Number | 1629001102
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Entity Type | Organization
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Legal Business Name | MEDEX DIAGNOSTIC AND TREATMENT CENTER LLC
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Dates
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Enumeration Date | 07/08/2006
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Last Update Date | 10/25/2023
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Provider Practice Location Address
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Address Line | 11129 QUEENS BLVD
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City | FOREST HILLS
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State | NY
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Zip | 11375-5553
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Country | US
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Telephone | 718-275-8900
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Fax | 718-785-0430
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Provider Business Mailing Address
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Address Line | 11129 QUEENS BLVD
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City | FOREST HILLS
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State | NY
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Zip | 11375-5553
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Country | US
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Telephone | 718-275-8900
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Fax | 718-785-0430
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Authorized Official
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Title or Position | OWNER
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Name | MR. OLEG ARONOV
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Credential |
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Telephone | 718-275-8900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 7003254R
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License Number State | NY
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