Organization · NPI-2

113th Street Medical Group, PC

Radiology, Diagnostic Radiology · Forest Hills, NY

NPI number1710186903

StatusActive

Last updated in NPPESJul 17, 2007

Details

NPI: 1710186903
Entity type: Organization (NPI-2)
Legal business name: 113th Street Medical Group, PC
Organization subpart: No
Enumeration date: Jul 17, 2007
Last updated: Jul 17, 2007

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
2085R0202X	Radiology, Diagnostic Radiology	–	–	Yes
2085B0100X	Radiology, Body Imaging	–	–
2085D0003X	Radiology, Diagnostic Neuroimaging	–	–
2085N0904X		–	–
2085R0203X	Radiology, Therapeutic Radiology	–	–
2085R0204X	Radiology, Vascular & Interventional Radiology	–	–
2085U0001X	Radiology, Diagnostic Ultrasound	–	–

Practice location

7035 113th St
Forest Hills, NY 11375-4651

Phone 718-990-4255 · Fax 718-990-4624

Mailing address

7035 113th St
Forest Hills, NY 11375-4651

Phone 718-990-4255 · Fax 718-990-4624

Authorized official

Girish N Desai
Director
7189904645

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