Provider Demographics
NPI:1154512267
Name:PROFESSIONAL DIAGNOSTIC SONOGRAPHY, INC
Entity Type:Organization
Organization Name:PROFESSIONAL DIAGNOSTIC SONOGRAPHY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GERARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:PALERMO
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS, RDCS, RVT
Authorized Official - Phone:718-386-8137
Mailing Address - Street 1:6545 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-7028
Mailing Address - Country:US
Mailing Address - Phone:718-386-8137
Mailing Address - Fax:718-386-7908
Practice Address - Street 1:6545 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-7028
Practice Address - Country:US
Practice Address - Phone:718-386-8137
Practice Address - Fax:718-386-7908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty
No246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonographyGroup - Single Specialty
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular SonographyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04461Medicare PIN