1184888745 NPI number — HEALTHCARE ASSOCIATES IN MEDICINE PC

Table of content: (NPI 1184888745)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184888745 NPI number — HEALTHCARE ASSOCIATES IN MEDICINE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHCARE ASSOCIATES IN MEDICINE PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
IMAGING CENTER OF STATEN ISLAND
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184888745
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2535 ARTHUR KILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STATEN ISLAND
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10309-1207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-448-3210
Provider Business Mailing Address Fax Number:
718-984-2642

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
65 COLUMBUS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STATEN ISLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-448-3210
Provider Business Practice Location Address Fax Number:
718-816-9288
Provider Enumeration Date:
07/14/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BERKLEY
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
I
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
718-448-3210

Provider Taxonomy Codes

  • Taxonomy code: 2085D0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085N0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)