MEDICARE: FIRST CHOICE DIAGNOSTICS RADIOLOGY 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	2085N0700X	Neuroradiology Physician	202691	NY

General Provider Information

NPI Number	:	1578841839
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST CHOICE DIAGNOSTICS RADIOLOGY PC

Provider Business Mailing Address
First Line	:	PO BOX 754076
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-9076
Country	:	US
Telephone Number	:	718-850-7200
Fax Number	:

Provider Business Practice Location Address
First Line	:	11960 METROPOLITAN AVE
Second Line	:
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-2606
Country	:	US
Telephone Number	:	718-850-7200
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROBERT WAXMAN
Credential	:	MD
Telephone Number	:	718-850-7200

Provider Enumeration Date	:	08/03/2011
Last Update Date	:	08/03/2011

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