Provider Demographics
NPI:1922517598
Name:METROPOLITAN MEDICAL DIAGNOSTICS, PC
Entity Type:Organization
Organization Name:METROPOLITAN MEDICAL DIAGNOSTICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROSEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:METCALF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-698-3032
Mailing Address - Street 1:170 E 87TH ST APT E8C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-2256
Mailing Address - Country:US
Mailing Address - Phone:914-246-0599
Mailing Address - Fax:718-791-3162
Practice Address - Street 1:170 E 87TH ST APT E8C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-2256
Practice Address - Country:US
Practice Address - Phone:631-271-2291
Practice Address - Fax:631-277-2825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-26
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1922517598OtherCOMMERCIAL