Provider Demographics
NPI:1144803644
Name:MAIMONIDES DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:MAIMONIDES DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ADDE
Authorized Official - Middle Name:
Authorized Official - Last Name:KHANATAYEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-747-4132
Mailing Address - Street 1:205 ROCKAWAY AVE # 3008
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-5825
Mailing Address - Country:US
Mailing Address - Phone:718-747-4132
Mailing Address - Fax:
Practice Address - Street 1:1701 AVENUE P STE M
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1205
Practice Address - Country:US
Practice Address - Phone:646-821-5229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile