MEDICARE: METROPOLITAN DIAGNOSTIC 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	2085R0202X	Diagnostic Radiology Physician	29015883	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	:	1982607198
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METROPOLITAN DIAGNOSTIC IMAGING, PC

Provider Business Mailing Address
First Line	:	601 FRANKLIN AVE
Second Line	:
City	:	GARDEN CITY
State	:	NY
Zip	:	11530-5795
Country	:	US
Telephone Number	:	516-747-0161
Fax Number	:	516-747-0166

Provider Business Practice Location Address
First Line	:	601 FRANKLIN AVE
Second Line	:
City	:	GARDEN CITY
State	:	NY
Zip	:	11530-5795
Country	:	US
Telephone Number	:	516-747-0161
Fax Number	:	516-747-0166

Authorized Official
Title or Position	:	DIRECTOR, MANAGED CARE
Name	:	MR. ANDREW WINAKOR
Credential	:
Telephone Number	:	516-616-5000

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	09/24/2007

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