Provider Demographics
NPI:1306065453
Name:ALLIANCE MEDICAL TECHNOLOGY
Entity type:Organization
Organization Name:ALLIANCE MEDICAL TECHNOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:COHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-445-5458
Mailing Address - Street 1:PO BOX 305
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-0305
Mailing Address - Country:US
Mailing Address - Phone:718-445-5458
Mailing Address - Fax:718-939-3462
Practice Address - Street 1:3 THE GRASSLANDS
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-1118
Practice Address - Country:US
Practice Address - Phone:718-445-5458
Practice Address - Fax:718-939-3462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY170790174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty