Provider Demographics
NPI:1265606750
Name:ADVANCED MEDICAL DIAGNOSTICS OF QUEENS PC
Entity type:Organization
Organization Name:ADVANCED MEDICAL DIAGNOSTICS OF QUEENS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NODARI
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKHELASHVILI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-279-1300
Mailing Address - Street 1:6829 SPRINGFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-2632
Mailing Address - Country:US
Mailing Address - Phone:718-279-1300
Mailing Address - Fax:718-279-1041
Practice Address - Street 1:6829 SPRINGFIELD BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-2632
Practice Address - Country:US
Practice Address - Phone:718-279-1300
Practice Address - Fax:718-279-1041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty