Provider Demographics
NPI:1942685649
Name:COMPREHENSIVE DIAGNOSTIC IMAGING SERVICES P.C.
Entity type:Organization
Organization Name:COMPREHENSIVE DIAGNOSTIC IMAGING SERVICES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BONO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-681-2842
Mailing Address - Street 1:8635 QUEENS BLVD
Mailing Address - Street 2:SUITE 2LM
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4434
Mailing Address - Country:US
Mailing Address - Phone:844-654-6235
Mailing Address - Fax:941-681-2845
Practice Address - Street 1:8635 QUEENS BLVD
Practice Address - Street 2:SUITE 2LM
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4434
Practice Address - Country:US
Practice Address - Phone:844-654-6235
Practice Address - Fax:941-681-2845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1839572085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02377324Medicaid
NYG73572Medicare UPIN
NY2637DFMedicare PIN