Organization
INTEGRATED MEDICAL DIAGNOSTIC SERVICES, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE CLANCY (EXECUTIVE ADMINISTRATOR)
(877) 646-2228
Entity
Organization
Contact information
Practice address
2171 JERICHO TPKE, SUITE 100, COMMACK, NY 11725-2937
(877) 646-2228
(877) 922-3329
Mailing address
PO BOX 13023, HAUPPAUGE, NY 11788-0535
(877) 646-2228
(877) 922-3329
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
180648-1
NY
2085N0700X
Neuroradiology Physician
—
—
2085N0904X
Nuclear Radiology Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
Other
Enumeration date
01/08/2013
Last updated
08/24/2015
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