Provider Demographics
NPI:1356782916
Name:INWOOD MEDICAL DIAGNOSTIC, P.C.
Entity type:Organization
Organization Name:INWOOD MEDICAL DIAGNOSTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LENIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FERMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-781-1900
Mailing Address - Street 1:PO BOX 763
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-0594
Mailing Address - Country:US
Mailing Address - Phone:212-781-1900
Mailing Address - Fax:212-781-7359
Practice Address - Street 1:629 W 185TH ST BSMT
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-3102
Practice Address - Country:US
Practice Address - Phone:212-781-1900
Practice Address - Fax:212-781-7359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-11
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY119573261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology