Integrated Medical Diagnostic Services, P.C.

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

180648-1 Issued in NY

Legal business name

INTEGRATED MEDICAL DIAGNOSTIC SERVICES, P.C.

Practice address

2171 Jericho Tpke
Suite 100
Commack, NY 11725-2937

Phone

(877) 646-2228

Fax

(877) 922-3329

NPI assigned

Jan 8, 2013

Organization subpart

No

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

Authorized official

Name

Michelle Clancy

Title

Executive Administrator

Phone

(877) 646-2228

Specialties & licenses 4

Addresses

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

{
    "created_epoch": "1357603200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1440374400000",
    "number": "1740527993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 13023",
            "city": "HAUPPAUGE",
            "state": "NY",
            "postal_code": "117880535",
            "telephone_number": "877-646-2228",
            "fax_number": "877-922-3329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2171 JERICHO TPKE",
            "address_2": "SUITE 100",
            "city": "COMMACK",
            "state": "NY",
            "postal_code": "117252937",
            "telephone_number": "877-646-2228",
            "fax_number": "877-922-3329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED MEDICAL DIAGNOSTIC SERVICES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-08",
        "last_updated": "2015-08-24",
        "status": "A",
        "authorized_official_last_name": "CLANCY",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "EXECUTIVE ADMINISTRATOR",
        "authorized_official_telephone_number": "877-646-2228"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NY",
            "license": "180648-1",
            "primary": true
        },
        {
            "code": "2085N0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Neuroradiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085N0904X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Nuclear Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Cardiovascular Disease Physician in Commack, NY
• Providers in Commack, NY by specialty
• Cardiovascular Disease Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2015; 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.