MEDICARE: DIAGNOSTIC MEDICAL IMAGING PLLC

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	2085R0202X	Diagnostic Radiology Physician	147975-1	NY

General Provider Information

NPI Number	:	1902338445
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIAGNOSTIC MEDICAL IMAGING PLLC

Provider Business Mailing Address
First Line	:	19 GIRARD ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3007
Country	:	US
Telephone Number	:	718-866-7796
Fax Number	:

Provider Business Practice Location Address
First Line	:	19 GIRARD ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3007
Country	:	US
Telephone Number	:	718-866-7796
Fax Number	:

Authorized Official
Title or Position	:	SOLE MBR
Name	:	DR. ELIEZER OFFENBACHER
Credential	:	MD
Telephone Number	:	718-866-7796

Provider Enumeration Date	:	04/03/2017
Last Update Date	:	04/03/2017

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