Provider Demographics
NPI:1629409933
Name:MEDICAL DIAGNOSTIC SERVICES PC
Entity Type:Organization
Organization Name:MEDICAL DIAGNOSTIC SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NILAY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:866-335-4040
Mailing Address - Street 1:520 WHITE PLAINS RD STE 500
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-5118
Mailing Address - Country:US
Mailing Address - Phone:866-335-4040
Mailing Address - Fax:800-362-2262
Practice Address - Street 1:520 WHITE PLAINS RD STE 500
Practice Address - Street 2:
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-5118
Practice Address - Country:US
Practice Address - Phone:866-335-4040
Practice Address - Fax:800-362-2262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2278522084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
113615Medicare PIN