Provider Demographics
NPI:1093839847
Name:BROOKLYN NUCLEAR SPECT IMAGING
Entity Type:Organization
Organization Name:BROOKLYN NUCLEAR SPECT IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:VACCARINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-368-1200
Mailing Address - Street 1:7515 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-2409
Mailing Address - Country:US
Mailing Address - Phone:718-234-8111
Mailing Address - Fax:
Practice Address - Street 1:7515 13TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-2409
Practice Address - Country:US
Practice Address - Phone:718-234-8111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W20021Medicare ID - Type Unspecified