Provider Demographics
NPI:1285757229
Name:VASCULAR LAB
Entity type:Organization
Organization Name:VASCULAR LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF VASCULAR LABS
Authorized Official - Prefix:
Authorized Official - First Name:DINKER
Authorized Official - Middle Name:B
Authorized Official - Last Name:RAI
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:718-613-4090
Mailing Address - Street 1:1545 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-1122
Mailing Address - Country:US
Mailing Address - Phone:718-613-4090
Mailing Address - Fax:718-837-0398
Practice Address - Street 1:1545 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-1122
Practice Address - Country:US
Practice Address - Phone:718-613-4090
Practice Address - Fax:718-837-0398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1287291174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00335626Medicaid
NY00335626Medicaid
NYW11061Medicare ID - Type Unspecified