MEDICARE: MC IMAGING INC

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	261QR0208X	Mobile Radiology Clinic/Center	122536	NY

General Provider Information

NPI Number	:	1376920496
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MC IMAGING INC

Provider Business Mailing Address
First Line	:	216 FOSTER PL STE 2
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10471-1805
Country	:	US
Telephone Number	:	201-492-7248
Fax Number	:

Provider Business Practice Location Address
First Line	:	216 FOSTER PL STE 2
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10471-1805
Country	:	US
Telephone Number	:	201-492-7248
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARIA CACERES
Credential	:	RDMS(AB)
Telephone Number	:	201-492-7248

Provider Enumeration Date	:	04/27/2015
Last Update Date	:	04/27/2015

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