Provider Demographics
NPI:1447761382
Name:PIVOT IMAGING, INC
Entity type:Organization
Organization Name:PIVOT IMAGING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:TKEBUCHAVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-513-6492
Mailing Address - Street 1:2084 E 8TH ST STE 2R
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-4127
Mailing Address - Country:US
Mailing Address - Phone:718-513-6492
Mailing Address - Fax:347-619-0108
Practice Address - Street 1:2084 E 8TH ST STE 2R
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-4127
Practice Address - Country:US
Practice Address - Phone:718-513-6492
Practice Address - Fax:347-619-0108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty