Provider Demographics
NPI:1578744785
Name:AIM 4 LIFE MEDICAL DIAGNOSTICS PC
Entity Type:Organization
Organization Name:AIM 4 LIFE MEDICAL DIAGNOSTICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:NODARI
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKHELASHVILI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-279-0020
Mailing Address - Street 1:3820 208TH ST
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-1929
Mailing Address - Country:US
Mailing Address - Phone:718-279-0020
Mailing Address - Fax:
Practice Address - Street 1:6829 SPRINGFIELD BLVD
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11365
Practice Address - Country:US
Practice Address - Phone:718-279-0020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Single Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty