MEDICARE: MEDICAL DIAGNOSTIC SERVICES 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	2084N0400X	Neurology Physician	227852	NY

General Provider Information

NPI Number	:	1629409933
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL DIAGNOSTIC SERVICES PC

Provider Business Mailing Address
First Line	:	520 WHITE PLAINS RD STE 500
Second Line	:
City	:	TARRYTOWN
State	:	NY
Zip	:	10591-5118
Country	:	US
Telephone Number	:	866-335-4040
Fax Number	:	800-362-2262

Provider Business Practice Location Address
First Line	:	520 WHITE PLAINS RD STE 500
Second Line	:
City	:	TARRYTOWN
State	:	NY
Zip	:	10591-5118
Country	:	US
Telephone Number	:	866-335-4040
Fax Number	:	800-362-2262

Authorized Official
Title or Position	:	CEO
Name	:	DR. NILAY SHAH
Credential	:	M.D.
Telephone Number	:	866-335-4040

Provider Enumeration Date	:	12/12/2013
Last Update Date	:	12/12/2013

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