MEDICARE: COMPREHENSIVE MEDICAL DIAGNOSTIC, 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	2471V0105X	Vascular Sonography Radiologic Technologist
2	246XS1301X	Sonography Specialist/Technologist Cardiovascular

General Provider Information

NPI Number	:	1619103470
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPREHENSIVE MEDICAL DIAGNOSTIC, PC

Provider Business Mailing Address
First Line	:	2108 W 7TH ST
Second Line	:	SUITE D
City	:	BROOKLYN
State	:	NY
Zip	:	11223-3754
Country	:	US
Telephone Number	:	347-492-3500
Fax Number	:	347-492-3499

Provider Business Practice Location Address
First Line	:	2108 W 7TH ST
Second Line	:	SUITE D
City	:	BROOKLYN
State	:	NY
Zip	:	11223-3754
Country	:	US
Telephone Number	:	347-492-3500
Fax Number	:	347-492-3499

Authorized Official
Title or Position	:	MANAGER
Name	:	KRISTINA MIRBABAYEVA
Credential	:
Telephone Number	:	347-492-3500

Provider Enumeration Date	:	06/08/2009
Last Update Date	:	09/01/2011

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