Provider Demographics
NPI:1578197729
Name:NORTH SHORE ONSITE MEDICAL DIAGNOSTIC P.C.
Entity Type:Organization
Organization Name:NORTH SHORE ONSITE MEDICAL DIAGNOSTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SEDIQUE
Authorized Official - Middle Name:S
Authorized Official - Last Name:MOHAMMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-620-4246
Mailing Address - Street 1:7 CENTER DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASTON
Mailing Address - State:NY
Mailing Address - Zip Code:11363-1213
Mailing Address - Country:US
Mailing Address - Phone:516-620-4246
Mailing Address - Fax:
Practice Address - Street 1:7418 41ST AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5601
Practice Address - Country:US
Practice Address - Phone:516-620-4246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty