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NPI Code Detail

MEDICARE: SOHO DIAGNOSTICS INK CORPORATION

MEDICARE: SOHO DIAGNOSTICS INK CORPORATION
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QR0208XMobile Radiology Clinic/Center

General Provider Information

NPI Number : 1063111938
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOHO DIAGNOSTICS INK CORPORATION
Provider Business Mailing Address
First Line : PO BOX 194
Second Line :
City : MAMARONECK
State : NY
Zip : 10543-0194
Country : US
Telephone Number : 855-682-2455
Fax Number : 855-835-5857
Provider Business Practice Location Address
First Line : 154 E BOSTON POST RD
Second Line :
City : MAMARONECK
State : NY
Zip : 10543-3736
Country : US
Telephone Number : 917-224-1677
Fax Number : 718-216-0019
Authorized Official
Title or Position : OWNER
Name : JAMES THOMAS BECKER
Credential :
Telephone Number : 855-682-2455
Provider Enumeration Date : 02/28/2023
Last Update Date : 11/27/2023

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