NPIMap

Organization Active NPI

Church-McDonald Medical Diagnostic PLLC

  • Pain Clinic/Center
  • Brooklyn, NY
National Provider Identifier
1700234358
Registry record updated May 24, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Clinic/CenterTaxonomy code 261QP3300X
License
239768 Issued in NY
Legal business name
CHURCH-MCDONALD MEDICAL DIAGNOSTIC PLLC
Practice address
486 McDonald Ave
Brooklyn, NY 11432
Phone
(352) 399-5085
Fax
(866) 402-3481
NPI assigned
May 24, 2016
Last updated
May 24, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 24, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Tina Shallonis
Title
Billing Manager
Phone
(352) 399-5085

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Clinic/Center 261QP3300X 239768 NY Primary

Addresses

Primary practice location

486 McDonald Ave
Brooklyn, NY 11432

Mailing address

486 McDonald Ave
Brooklyn, NY 11432
Phone (352) 399-5085

National Provider Directory

National Provider Directory
Tax ID family
Church-McDonald Medical Diagnosis PLLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1464048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464048000000",
    "number": "1700234358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "486 MCDONALD AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "11432",
            "telephone_number": "352-399-5085",
            "fax_number": "866-402-3481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "486 MCDONALD AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "11432",
            "telephone_number": "352-399-5085",
            "fax_number": "866-402-3481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHURCH-MCDONALD MEDICAL DIAGNOSTIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-24",
        "last_updated": "2016-05-24",
        "status": "A",
        "authorized_official_last_name": "SHALLONIS",
        "authorized_official_first_name": "TINA",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "352-399-5085",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": "NY",
            "license": "239768",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.