MEDICARE: ECLIPSE MEDICAL IMAGING 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	174400000X	Specialist	124001-2	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	:	1780121228
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ECLIPSE MEDICAL IMAGING PC

Provider Business Mailing Address
First Line	:	651 CONEY ISLAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-4379
Country	:	US
Telephone Number	:	718-284-0700
Fax Number	:	718-284-0800

Provider Business Practice Location Address
First Line	:	651 CONEY ISLAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-4379
Country	:	US
Telephone Number	:	718-284-0700
Fax Number	:	718-284-0800

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JACK L BALDASAR
Credential	:	M.D.
Telephone Number	:	718-284-0700

Provider Enumeration Date	:	01/23/2017
Last Update Date	:	01/23/2017

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Directions to “ECLIPSE MEDICAL IMAGING PC ” Practice Location

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