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General NPI Number Information
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NPI Number | 1669760666
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Entity Type | Organization
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Legal Business Name | INNOVATIVE MEDICAL DIAGNOSTIC CARE, PC
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Dates
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Enumeration Date | 07/12/2011
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Last Update Date | 07/13/2011
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Provider Practice Location Address
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Address Line | 1825 MADISON AVE
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City | NEW YORK
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State | NY
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Zip | 10035-3829
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Country | US
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Telephone | 212-860-3500
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Fax | 212-860-3531
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Provider Business Mailing Address
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Address Line | PO BOX 48340
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City | NEWARK
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State | NJ
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Zip | 07101-8540
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Country | US
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Telephone | 212-860-3500
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Fax | 212-860-3531
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | SATISH CHANDRA
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Credential | MD
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Telephone | 212-860-3500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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