=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922051630
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EAST MANHATTAN DIAGNOSTIC IMAGING, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2006
-----------------------------------------------------
Last Update Date | 02/11/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 424 E 89TH ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10128-6703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-410-5100
-----------------------------------------------------
Fax | 212-410-2500
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 10270
-----------------------------------------------------
City | UNIONDALE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11555-0270
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-830-3122
-----------------------------------------------------
Fax | 201-200-0838
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | KEVIN MATH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 201-830-3122
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------