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General NPI Number Information
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NPI Number | 1720238132
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Entity Type | Organization
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Legal Business Name | SPECTRUM MEDICAL IMAGING & CONSULTING SERVICES, PC
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Dates
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Enumeration Date | 09/22/2008
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Last Update Date | 09/22/2008
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Provider Practice Location Address
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Address Line | 563 CEDAR SWAMP RD
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City | GLEN HEAD
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State | NY
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Zip | 11545-2237
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Country | US
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Telephone | 917-567-6249
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Fax |
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Provider Business Mailing Address
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Address Line | 563 CEDAR SWAMP RD
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City | GLEN HEAD
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State | NY
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Zip | 11545-2237
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Country | US
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Telephone | 917-567-6249
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EMMANUEL I VARKARIS
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Credential | M.D.
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Telephone | 917-567-6249
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 225098
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License Number State | NY
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