Provider Demographics
NPI:1659153799
Name:CNN DIAGNOSTIC INC
Entity Type:Organization
Organization Name:CNN DIAGNOSTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:A
Authorized Official - Last Name:NICOLEAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:718-344-5293
Mailing Address - Street 1:28 WINCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:GLEN HEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11545-3203
Mailing Address - Country:US
Mailing Address - Phone:347-771-5099
Mailing Address - Fax:
Practice Address - Street 1:8710 NORTHERN BLVD FL 2
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-1641
Practice Address - Country:US
Practice Address - Phone:347-771-5099
Practice Address - Fax:877-796-4457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty