MEDICARE: MEDEX DIAGNOSTIC AND TREATMENT CENTER 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	261Q00000X	Clinic/Center	7003254R	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629001102
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDEX DIAGNOSTIC AND TREATMENT CENTER LLC

Provider Business Mailing Address
First Line	:	11129 QUEENS BLVD
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-5553
Country	:	US
Telephone Number	:	718-275-8900
Fax Number	:	718-785-0430

Provider Business Practice Location Address
First Line	:	11129 QUEENS BLVD
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-5553
Country	:	US
Telephone Number	:	718-275-8900
Fax Number	:	718-785-0430

Authorized Official
Title or Position	:	OWNER
Name	:	MR. OLEG ARONOV
Credential	:
Telephone Number	:	718-275-8900

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	10/25/2023

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