MEDICARE: IMAGING CONSULTANTS AND BILLING OF NY, 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	293D00000X	Physiological Laboratory

General Provider Information

NPI Number	:	1508308693
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMAGING CONSULTANTS AND BILLING OF NY, LLC

Provider Business Mailing Address
First Line	:	2152 RALPH AVE
Second Line	:	SUITE 230
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5406
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1249 E 68TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5721
Country	:	US
Telephone Number	:	347-702-9302
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	KEITH JANAL
Credential	:
Telephone Number	:	917-399-5573

Provider Enumeration Date	:	11/07/2016
Last Update Date	:	11/07/2016

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