Provider Demographics
NPI:1649291790
Name:PET-CT DIAGNOSTIC MEDICAL IMAGING PC
Entity type:Organization
Organization Name:PET-CT DIAGNOSTIC MEDICAL IMAGING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:PRAGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-931-2300
Mailing Address - Street 1:1200 WATERS PL
Mailing Address - Street 2:SUITE M108
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2728
Mailing Address - Country:US
Mailing Address - Phone:718-931-2300
Mailing Address - Fax:
Practice Address - Street 1:1200 WATERS PL
Practice Address - Street 2:SUITE M108
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2728
Practice Address - Country:US
Practice Address - Phone:718-931-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW31091Medicare PIN