Provider Demographics
NPI:1891015947
Name:CENTRAL PARK DIAGNOSTIC, INC
Entity Type:Organization
Organization Name:CENTRAL PARK DIAGNOSTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHNOZ
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSTAMOVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-974-0490
Mailing Address - Street 1:134 W 58TH ST
Mailing Address - Street 2:STE. 102
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-2153
Mailing Address - Country:US
Mailing Address - Phone:212-974-0490
Mailing Address - Fax:212-974-0493
Practice Address - Street 1:134 W 58TH ST
Practice Address - Street 2:STE. 102
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2153
Practice Address - Country:US
Practice Address - Phone:212-974-0490
Practice Address - Fax:212-974-0493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-10
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245082174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty