MEDICARE: SCREEN MEDICAL IMAGING PC

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	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1154690386
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCREEN MEDICAL IMAGING PC

Provider Business Mailing Address
First Line	:	140 RIVERSIDE BLVD
Second Line	:	APT 811
City	:	NEW YORK
State	:	NY
Zip	:	10069-0601
Country	:	US
Telephone Number	:	347-590-2707
Fax Number	:	347-590-2706

Provider Business Practice Location Address
First Line	:	953 SOUTHERN BLVD
Second Line	:	LOBBY
City	:	BRONX
State	:	NY
Zip	:	10459-3428
Country	:	US
Telephone Number	:	347-590-2707
Fax Number	:	347-590-2706

Authorized Official
Title or Position	:	OWNER
Name	:	YEFIM VAYNSHELBAUM
Credential	:	MD
Telephone Number	:	347-590-2707

Provider Enumeration Date	:	12/16/2011
Last Update Date	:	12/16/2011

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