Provider Demographics
NPI:1669760666
Name:INNOVATIVE MEDICAL DIAGNOSTIC CARE, PC
Entity type:Organization
Organization Name:INNOVATIVE MEDICAL DIAGNOSTIC CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SATISH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-860-3500
Mailing Address - Street 1:PO BOX 48340
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07101-8540
Mailing Address - Country:US
Mailing Address - Phone:212-860-3500
Mailing Address - Fax:212-860-3531
Practice Address - Street 1:1825 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-3829
Practice Address - Country:US
Practice Address - Phone:212-860-3500
Practice Address - Fax:212-860-3531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-12
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology