Woodside Medical Diagnostic, PC.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

178659 Issued in NY

Legal business name

WOODSIDE MEDICAL DIAGNOSTIC, PC.

Practice address

3120 54TH St
Suite L2
Woodside, NY 11377-1530

Phone

(718) 476-5859

Fax

(718) 476-9859

NPI assigned

Jun 12, 2007

Organization subpart

No

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

Authorized official

Name

Endora I. Dragomir

Title

Biller

Phone

(718) 545-5947

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1181606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1271203200000",
    "number": "1952505331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3120 54TH ST",
            "address_2": "SUITE L2",
            "city": "WOODSIDE",
            "state": "NY",
            "postal_code": "113771530",
            "telephone_number": "718-476-5859",
            "fax_number": "718-476-9859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3120 54TH ST",
            "address_2": "SUITE L2",
            "city": "WOODSIDE",
            "state": "NY",
            "postal_code": "113771530",
            "telephone_number": "718-476-5859",
            "fax_number": "718-476-9859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOODSIDE MEDICAL DIAGNOSTIC, PC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-12",
        "last_updated": "2010-04-14",
        "status": "A",
        "authorized_official_last_name": "DRAGOMIR",
        "authorized_official_first_name": "ENDORA",
        "authorized_official_middle_name": "I.",
        "authorized_official_title_or_position": "BILLER",
        "authorized_official_telephone_number": "718-545-5947"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "178659",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01130987",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Woodside Dental Center P.C.
• Woodside Eye Care Inc
• Woodside Family Dental PLLC
• Woodside Medical Care
• Woodside Medical Care P.C
• Woodside Medical Practice, P.C.
• Woodside Medical Services PC
• Woodside Physical Therapy Rehabilitation PLLC
• Woodside Vision Inc
• Kateri Wright

• Internal Medicine Physician in Woodside, NY
• Providers in Woodside, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2010; 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.