Provider Demographics
NPI:1720383334
Name:ALL ISLAND DIAGNOSTIC MEDICAL PC
Entity Type:Organization
Organization Name:ALL ISLAND DIAGNOSTIC MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:212-255-2333
Mailing Address - Street 1:1069 MAIN STREET
Mailing Address - Street 2:SUITE 334
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741
Mailing Address - Country:US
Mailing Address - Phone:212-255-2333
Mailing Address - Fax:212-255-2333
Practice Address - Street 1:1069 MAIN ST
Practice Address - Street 2:SUITE 334
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-1618
Practice Address - Country:US
Practice Address - Phone:212-255-2333
Practice Address - Fax:212-255-2455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204062174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty