Provider Demographics
NPI:1578154241
Name:NORTH EAST MEDICAL DIAGNOSTICS, PC
Entity Type:Organization
Organization Name:NORTH EAST MEDICAL DIAGNOSTICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:FRANKEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-774-4195
Mailing Address - Street 1:1129 NORTHERN BLVD STE 404
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3022
Mailing Address - Country:US
Mailing Address - Phone:516-774-4195
Mailing Address - Fax:516-362-6252
Practice Address - Street 1:1129 NORTHERN BLVD STE 404
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3022
Practice Address - Country:US
Practice Address - Phone:516-774-4195
Practice Address - Fax:516-362-6252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-26
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01835363Medicaid