Provider Demographics
NPI:1710366729
Name:NYC DIAGNOSTIC MEDICAL P.C.
Entity Type:Organization
Organization Name:NYC DIAGNOSTIC MEDICAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:RUDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-770-2060
Mailing Address - Street 1:622 AVENUE X
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6120
Mailing Address - Country:US
Mailing Address - Phone:917-770-2060
Mailing Address - Fax:347-338-2800
Practice Address - Street 1:622 AVENUE X
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6120
Practice Address - Country:US
Practice Address - Phone:917-770-2060
Practice Address - Fax:347-338-2800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-22
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2077861207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty