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General NPI Number Information
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NPI Number | 1740525906
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Entity Type | Organization
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Legal Business Name | DESTINO MEDICAL DIAGNOSTICS PC
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Dates
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Enumeration Date | 11/29/2012
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Last Update Date | 11/29/2012
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Provider Practice Location Address
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Address Line | 202 FALLWOOD PKWY
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City | FARMINGDALE
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State | NY
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Zip | 11735-4929
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Country | US
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Telephone | 631-834-9380
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Fax |
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Provider Business Mailing Address
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Address Line | 202 FALLWOOD PKWY
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City | FARMINGDALE
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State | NY
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Zip | 11735-4929
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Country | US
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Telephone | 631-834-9380
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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. SALVATORE TRAZZERA
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Credential | M.D.
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Telephone | 516-834-9380
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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