MEDICARE: CHURCH-MCDONALD MEDICAL DIAGNOSIS PLLC

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	335V00000X	Portable X-ray and/or Other Portable Diagnostic Imaging Supplier

General Provider Information

NPI Number	:	1386191633
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHURCH-MCDONALD MEDICAL DIAGNOSIS PLLC

Provider Business Mailing Address
First Line	:	486 MCDONALD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-3812
Country	:	US
Telephone Number	:	718-247-7226
Fax Number	:	914-500-6570

Provider Business Practice Location Address
First Line	:	486 MCDONALD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-3812
Country	:	US
Telephone Number	:	718-247-7226
Fax Number	:	914-500-6570

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. INAMULHAQUE M SABOOR
Credential	:	M.D.
Telephone Number	:	718-247-7226

Provider Enumeration Date	:	09/03/2016
Last Update Date	:	09/03/2016

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