MEDICARE: DIRECT IMAGERY CARE LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1336711720
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIRECT IMAGERY CARE LLC

Provider Business Mailing Address
First Line	:	350 RICHMOND TER APT 3S
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-1519
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 RICHMOND TER APT 3S
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-1519
Country	:	US
Telephone Number	:	917-861-6376
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MR. IDRIS OJELADE
Credential	:
Telephone Number	:	347-414-4456

Provider Enumeration Date	:	07/14/2021
Last Update Date	:	07/14/2021

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Directions to “DIRECT IMAGERY CARE LLC ” Practice Location

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