Provider Demographics
NPI:1194255562
Name:NEW YORK MEDICAL & DIAGNOSTIC CARE PC
Entity type:Organization
Organization Name:NEW YORK MEDICAL & DIAGNOSTIC CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NAIYER
Authorized Official - Middle Name:
Authorized Official - Last Name:IMAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-529-5472
Mailing Address - Street 1:20416 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-2217
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20416 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-2217
Practice Address - Country:US
Practice Address - Phone:718-412-9990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-18
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty