Basic Information
| Provider Information | |||||||||
| NPI: | 1235288580 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MEDICAL IMAGING OF MANHATTAN,LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 106 E 61ST ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100658102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127942500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 106 E 61ST ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100658102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127942500 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2007 | ||||||||
| LastUpdateDate: | 04/15/2020 | ||||||||
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| AuthorizedOfficialLastName: | WILSON-DANIEL | ||||||||
| AuthorizedOfficialFirstName: | MARCI | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ACCOUNTING SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 2127942500 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| NPICertificationDate: | 04/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.