Organization
VANESSA PERO MEDICAL DIAGNOSTIC SERVICES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VANESSA THERESA THERESA MD (OWNER)
(718) 267-8196
Entity
Organization
Contact information
Practice address
458 MAIN ST, PORT WASHINGTON, NY 11050-3123
(718) 267-8196
Mailing address
365 MINEOLA BLVD, MINEOLA, NY 11501-1526
(718) 267-8196
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
167430
NY
2085R0202X
Diagnostic Radiology Physician
Primary
167342
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1174734859
INDIVIDUAL NPI
NY
Enumeration date
05/24/2007
Last updated
09/11/2025
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