Provider Demographics
NPI:1063111938
Name:SOHO DIAGNOSTICS INK CORPORATION
Entity type:Organization
Organization Name:SOHO DIAGNOSTICS INK CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-682-2455
Mailing Address - Street 1:PO BOX 194
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-0194
Mailing Address - Country:US
Mailing Address - Phone:855-682-2455
Mailing Address - Fax:855-835-5857
Practice Address - Street 1:154 E BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-3736
Practice Address - Country:US
Practice Address - Phone:917-224-1677
Practice Address - Fax:718-216-0019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-28
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile