MEDICARE: EKHOSDIAGNOSTICS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	2085U0001X	Diagnostic Ultrasound Physician
2	246XS1301X	Sonography Specialist/Technologist Cardiovascular
3	2471V0105X	Vascular Sonography Radiologic Technologist
4	335V00000X	Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
5	261QR0208X	Mobile Radiology Clinic/Center

General Provider Information

NPI Number	:	1760158497
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EKHOSDIAGNOSTICS LLC

Provider Business Mailing Address
First Line	:	414 59TH ST APT 2
Second Line	:
City	:	WEST NEW YORK
State	:	NJ
Zip	:	07093-1172
Country	:	US
Telephone Number	:	201-606-3693
Fax Number	:

Provider Business Practice Location Address
First Line	:	414 59TH ST APT 2
Second Line	:
City	:	WEST NEW YORK
State	:	NJ
Zip	:	07093-1172
Country	:	US
Telephone Number	:	201-606-3693
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	FEDOR ZAKHAROV
Credential	:
Telephone Number	:	201-606-3693

Provider Enumeration Date	:	08/22/2021
Last Update Date	:	11/17/2021

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