MEDICARE: QUALITY DIAGNOSTIC, 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	:	1669712741
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUALITY DIAGNOSTIC, INC

Provider Business Mailing Address
First Line	:	2167 CRUGER AVE APT 6C
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-1519
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2167 CRUGER AVE APT 6C
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-1519
Country	:	US
Telephone Number	:	646-373-5329
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CESAR C MALPARTIDA
Credential	:
Telephone Number	:	646-373-4329

Provider Enumeration Date	:	02/26/2013
Last Update Date	:	02/26/2013

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