MEDICARE: QUALITY DIAGNOSTIC 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	114166	NY

General Provider Information

NPI Number	:	1285704817
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUALITY DIAGNOSTIC IMAGING PC

Provider Business Mailing Address
First Line	:	2104 E 24TH STREET
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229
Country	:	US
Telephone Number	:	718-616-2100
Fax Number	:	718-616-2056

Provider Business Practice Location Address
First Line	:	2104 EAST 24TH STREET
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229
Country	:	US
Telephone Number	:	718-616-2100
Fax Number	:	718-616-2056

Authorized Official
Title or Position	:	OWNER
Name	:	ZOYA MAKSUMOVA
Credential	:	MD
Telephone Number	:	718-616-2100

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	08/22/2020

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