Provider Demographics
NPI:1467715284
Name:IRON CLAD MEDICAL DIAGNOSTIC P.C.
Entity Type:Organization
Organization Name:IRON CLAD MEDICAL DIAGNOSTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:DENISE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-648-8860
Mailing Address - Street 1:PO BOX 94
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-0094
Mailing Address - Country:US
Mailing Address - Phone:631-648-8860
Mailing Address - Fax:631-676-7597
Practice Address - Street 1:3075 VETERANS MEMORIAL HWY
Practice Address - Street 2:SUITE 161
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-7667
Practice Address - Country:US
Practice Address - Phone:631-648-8860
Practice Address - Fax:631-676-7597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty