Provider Demographics
NPI:1518003359
Name:BROOKLYN NUCLEAR SPECT IMAGING, PC
Entity Type:Organization
Organization Name:BROOKLYN NUCLEAR SPECT IMAGING, PC
Other - Org Name:PARK SLOPE NUCLEAR SPECT IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:VACCARINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-965-0248
Mailing Address - Street 1:405 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-3315
Mailing Address - Country:US
Mailing Address - Phone:718-965-0248
Mailing Address - Fax:
Practice Address - Street 1:405 5TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-3315
Practice Address - Country:US
Practice Address - Phone:718-965-0248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty