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NPI Code Detail

MEDICARE: INTEGRATED DIAGNOSTIC IMAGING & CARDIOLOGY OF STATEN ISLAND P.C.

MEDICARE: INTEGRATED DIAGNOSTIC IMAGING & CARDIOLOGY OF STATEN ISLAND 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
1207RC0000XCardiovascular Disease Physician1306831NY
22085R0202XDiagnostic Radiology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21306831OTHERNYNY MEDICAL LICENSE

General Provider Information

NPI Number : 1174537948
Entity Type Code : Organization
Provider Name (Legal Business Name) : INTEGRATED DIAGNOSTIC IMAGING & CARDIOLOGY OF STATEN ISLAND P.C.
Provider Business Mailing Address
First Line : 2052 RICHMOND RD STE B
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10306-2583
Country : US
Telephone Number : 201-888-7877
Fax Number : 855-420-5931
Provider Business Practice Location Address
First Line : 2052 RICHMOND RD STE B
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10306-2583
Country : US
Telephone Number : 201-888-7877
Fax Number : 855-420-5931
Authorized Official
Title or Position : OWNER
Name : JOHN EDWARD STROBECK
Credential : MD
Telephone Number : 201-888-7877
Provider Enumeration Date : 07/28/2006
Last Update Date : 09/20/2023

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