Provider Demographics
NPI:1558960690
Name:NEW YORK MEDICAL DIAGNOSTIC IMAGING PC
Entity type:Organization
Organization Name:NEW YORK MEDICAL DIAGNOSTIC IMAGING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIFTEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-353-8988
Mailing Address - Street 1:295 NORTHERN BLVD STE 307
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-4701
Mailing Address - Country:US
Mailing Address - Phone:516-482-7775
Mailing Address - Fax:718-907-7910
Practice Address - Street 1:13617 39TH AVE STE 1D
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5504
Practice Address - Country:US
Practice Address - Phone:718-353-8988
Practice Address - Fax:718-285-7568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty