Provider Demographics
NPI:1316457518
Name:AB MEDICAL DIAGNOSTICS PC
Entity type:Organization
Organization Name:AB MEDICAL DIAGNOSTICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:HARRY
Authorized Official - Last Name:BRUCKSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-268-5505
Mailing Address - Street 1:499 CHESTNUT ST STE 216
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-2242
Mailing Address - Country:US
Mailing Address - Phone:516-268-5505
Mailing Address - Fax:516-332-8150
Practice Address - Street 1:499 CHESTNUT ST STE 216
Practice Address - Street 2:
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-2242
Practice Address - Country:US
Practice Address - Phone:516-268-5505
Practice Address - Fax:516-232-8150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-03
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM1300X
NY105427261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology