Provider Demographics
NPI:1679670806
Name:YONKERS MEDICAL DIAGNOSTIC,PC
Entity type:Organization
Organization Name:YONKERS MEDICAL DIAGNOSTIC,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ILYA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:BURSHTEYN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-963-0125
Mailing Address - Street 1:713 YONKERS AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-2657
Mailing Address - Country:US
Mailing Address - Phone:914-963-0125
Mailing Address - Fax:
Practice Address - Street 1:713 YONKERS AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-2657
Practice Address - Country:US
Practice Address - Phone:914-963-0125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty