Provider Demographics
NPI:1508240623
Name:C K MEDICAL DIAGNOSTIC SERVICES PC
Entity Type:Organization
Organization Name:C K MEDICAL DIAGNOSTIC SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CUSTIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-648-1300
Mailing Address - Street 1:2407 E 23RD ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2510
Mailing Address - Country:US
Mailing Address - Phone:718-648-1300
Mailing Address - Fax:718-648-3100
Practice Address - Street 1:2407 E 23RD ST
Practice Address - Street 2:SUITE A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-2510
Practice Address - Country:US
Practice Address - Phone:718-648-1300
Practice Address - Fax:718-648-3100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-18
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty