Organization
MODERN IMAGE OF NY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAISA EVANS (PRES.)
(718) 996-9088
Entity
Organization
Contact information
Practice address
2965 OCEAN PKWY, 507, BROOKLYN, NY 11235-8014
(718) 996-9088
(718) 535-7876
Mailing address
2965 OCEAN PKWY, 507, BROOKLYN, NY 11235-8014
(718) 996-9088
(718) 535-7876
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01832017
—
NY
Enumeration date
04/16/2007
Last updated
09/18/2009
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