Provider Demographics
NPI:1730414095
Name:MEDICAL DIAGNOSTIC OF BROOKLYN PLLC
Entity type:Organization
Organization Name:MEDICAL DIAGNOSTIC OF BROOKLYN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:YELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:LINCHEVSKAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-492-4515
Mailing Address - Street 1:1150 BRIGHTON BEACH AVE
Mailing Address - Street 2:1CC
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-5901
Mailing Address - Country:US
Mailing Address - Phone:347-492-4515
Mailing Address - Fax:347-492-4514
Practice Address - Street 1:1150 BRIGHTON BEACH AVE
Practice Address - Street 2:1CC
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5901
Practice Address - Country:US
Practice Address - Phone:347-492-4515
Practice Address - Fax:347-492-4514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-05
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251C2600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistCardiopulmonaryGroup - Multi-Specialty
No2251E1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistErgonomicsGroup - Multi-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty