Provider Demographics
NPI:1023435971
Name:MEDICAL DIAGNOSTIC IMAGING PLLC
Entity type:Organization
Organization Name:MEDICAL DIAGNOSTIC IMAGING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WALDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-818-1165
Mailing Address - Street 1:14 RAYMOND AVE
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-2312
Mailing Address - Country:US
Mailing Address - Phone:845-471-2848
Mailing Address - Fax:845-471-2919
Practice Address - Street 1:1323 ROUTE 9
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-4904
Practice Address - Country:US
Practice Address - Phone:845-471-2848
Practice Address - Fax:845-471-2919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-27
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY186503174400000X
261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty