Provider Demographics
NPI:1306012208
Name:BROOKLYN NUCLEAR SPECT IMAGING, P.C
Entity Type:Organization
Organization Name:BROOKLYN NUCLEAR SPECT IMAGING, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALDO
Authorized Official - Last Name:VACCARINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACC, CBNC
Authorized Official - Phone:718-837-0010
Mailing Address - Street 1:1435 86TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-3403
Mailing Address - Country:US
Mailing Address - Phone:718-837-0010
Mailing Address - Fax:718-837-1411
Practice Address - Street 1:1 PLAINFIELD AVE
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-1263
Practice Address - Country:US
Practice Address - Phone:516-326-7772
Practice Address - Fax:516-326-2749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY170563-1207R00000X, 207RC0000X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Multi-Specialty