Provider Demographics
NPI:1861883134
Name:ADVANCED DIAGNOSTICS AND MEDICAL IMAGING PA
Entity type:Organization
Organization Name:ADVANCED DIAGNOSTICS AND MEDICAL IMAGING PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIFTEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-804-6155
Mailing Address - Street 1:200 E 36TH ST APT 11C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-3648
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6770 INDIAN CREEK DR APT TSR
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33141-5709
Practice Address - Country:US
Practice Address - Phone:877-372-3266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1218522085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty