Provider Demographics
NPI:1629406673
Name:MEDISCAN
Entity Type:Organization
Organization Name:MEDISCAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:AVIGDOR
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:718-571-8010
Mailing Address - Street 1:4125 163RD ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-2657
Mailing Address - Country:US
Mailing Address - Phone:718-571-8010
Mailing Address - Fax:
Practice Address - Street 1:4125 163RD ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-2657
Practice Address - Country:US
Practice Address - Phone:718-571-8010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY610419251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care