MEDICARE: PREVENTIVE DIAGNOSTICS 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

General Provider Information

NPI Number	:	1588113963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREVENTIVE DIAGNOSTICS INC.

Provider Business Mailing Address
First Line	:	12 SPENCER ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11205-1891
Country	:	US
Telephone Number	:	718-388-3300
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 GROVE ST
Second Line	:
City	:	NEW BRITAIN
State	:	CT
Zip	:	06053-4116
Country	:	US
Telephone Number	:	718-388-3300
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MENACHEM TAUBER
Credential	:
Telephone Number	:	718-388-3300

Provider Enumeration Date	:	09/27/2016
Last Update Date	:	05/06/2019

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