Provider Demographics
NPI:1245674175
Name:PREVENTIVE IDTF INC.
Entity type:Organization
Organization Name:PREVENTIVE IDTF INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MENACHEM
Authorized Official - Middle Name:
Authorized Official - Last Name:TAUBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-388-3300
Mailing Address - Street 1:544 PARK AVE
Mailing Address - Street 2:610
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-1600
Mailing Address - Country:US
Mailing Address - Phone:718-388-3300
Mailing Address - Fax:
Practice Address - Street 1:544 PARK AVE
Practice Address - Street 2:610
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-1600
Practice Address - Country:US
Practice Address - Phone:718-388-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-22
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300087924Medicare UPIN
NYG300090963Medicare UPIN
NYJ300091538Medicare UPIN