Coney Island Medical Diagnostic Services P C

Primary specialty

Anatomic Pathology PhysicianTaxonomy code 207ZP0101X

Legal business name

CONEY ISLAND MEDICAL DIAGNOSTIC SERVICES P C

Practice address

1704 Mermaid Ave Ste 6
Brooklyn, NY 11224-2622

Phone

(516) 567-5410

NPI assigned

Jan 21, 2020

Organization subpart

No

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

Authorized official

Name

Dr. Konstantin Vaizman, MD

Title

Owner

Phone

(347) 446-6839

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shawn Shukuang Liu, M.D.

  • Anatomic Pathology Physician
  • New York, NY
  • NPI 1023338068
  Medicare reassignment NPD

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

{
    "created_epoch": "1579564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579564800000",
    "number": "1902436728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 86",
            "city": "JERICHO",
            "state": "NY",
            "postal_code": "117530086",
            "telephone_number": "516-567-5410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1704 MERMAID AVE STE 6",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112242622",
            "telephone_number": "516-567-5410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONEY ISLAND MEDICAL DIAGNOSTIC SERVICES P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-21",
        "last_updated": "2020-01-21",
        "certification_date": "2020-01-21",
        "status": "A",
        "authorized_official_last_name": "VAIZMAN",
        "authorized_official_first_name": "KONSTANTIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "347-446-6839",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ZP0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pathology, Anatomic Pathology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Coney Island Health Services, Inc.
• Coney Island Healthcare Medical P.C.
• Coney Island Hospital
• Coney Island Hospital
• Coney Island Hospital
• Coney Island Medical Practice Plan
• Coney Island Medical Practice Plan, P.C.
• Coney Island Medical Services PC
• Coney Island Pharmacy Inc
• Coney Island Physicians PC

• Anatomic Pathology Physician in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Anatomic Pathology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.