1548396203 NPI number — NUTAN ANAND, MD, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548396203 NPI number — NUTAN ANAND, MD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NUTAN ANAND, MD, 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:
LONG ISLAND DIAGNOSTIC IMAGING
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:
1548396203
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 LAFAYETTE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SYOSSET
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11791-3934
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-364-4600
Provider Business Mailing Address Fax Number:
516-364-4690

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 OSBORNE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIVERHEAD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11901-3021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-727-6025
Provider Business Practice Location Address Fax Number:
631-727-6025
Provider Enumeration Date:
02/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIDSON
Authorized Official First Name:
LORIE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
516-364-4600

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  51021887 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 51021887 . This is a "NYSDOH CERTIFICATION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 211029 . This is a "FDA CERTIFICATION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1902838816 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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