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General NPI Number Information
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NPI Number | 1912388299
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Entity Type | Organization
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Legal Business Name | EAST SHORE DIAGNOSTICS INC
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Dates
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Enumeration Date | 06/12/2015
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Last Update Date | 06/12/2015
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Provider Practice Location Address
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Address Line | 7506 16TH AVE STE2
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City | BROOKLYN
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State | NY
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Zip | 11214-1064
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Country | US
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Telephone | 818-731-9716
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Fax |
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Provider Business Mailing Address
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Address Line | 7506 16TH AVE STE2
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City | BROOKLYN
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State | NY
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Zip | 11214-1064
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Country | US
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Telephone | 818-731-9716
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RAMAZ MITAISHVILI
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Credential |
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Telephone | 818-731-9716
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0208X
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Taxonomy Name | Mobile Radiology Clinic/Center
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License Number |
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License Number State |
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