Provider Demographics
NPI:1235464470
Name:A.K. DIAGNOSTIC IMAGING, PC
Entity Type:Organization
Organization Name:A.K. DIAGNOSTIC IMAGING, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AYOOB
Authorized Official - Middle Name:
Authorized Official - Last Name:KHODADADI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-291-5251
Mailing Address - Street 1:17561 HILLSIDE AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-5733
Mailing Address - Country:US
Mailing Address - Phone:718-291-5251
Mailing Address - Fax:718-291-5252
Practice Address - Street 1:17561 HILLSIDE AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-5733
Practice Address - Country:US
Practice Address - Phone:718-291-5251
Practice Address - Fax:718-291-5252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113253-1261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY64441Medicare UPIN