Basic Information
| Provider Information | |||||||||
| NPI: | 1033193602 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | INKELES | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | ALAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 230 WEST 17 ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9173052615 | ||||||||
| FaxNumber: | 2126337844 | ||||||||
| Practice Location | |||||||||
| Address1: | 230 WEST 17 ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2129898999 | ||||||||
| FaxNumber: | 2129891992 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 0923341 | NY | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 00605867 | 05 | NY | MEDICAID |