MEDICARE: A. KHODADADI RADIOLOGY P.C.

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
1	173000000X	Legal Medicine	113253-1	NY

General Provider Information

NPI Number	:	1083664767
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A. KHODADADI RADIOLOGY P.C.

Provider Business Mailing Address
First Line	:	2678 GERRITSEN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-5947
Country	:	US
Telephone Number	:	718-333-0275
Fax Number	:	718-333-0224

Provider Business Practice Location Address
First Line	:	2678 GERRITSEN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-5947
Country	:	US
Telephone Number	:	718-333-0275
Fax Number	:	718-333-0224

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. AYOOB KHODADADI
Credential	:	M.D.,
Telephone Number	:	718-333-0207

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	04/11/2008

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