1740353838 NPI number — RADIOLOGY SERVICES OF NEW YORK, PC

Table of content: (NPI 1740353838)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740353838 NPI number — RADIOLOGY SERVICES OF NEW YORK, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RADIOLOGY SERVICES OF NEW YORK, 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:
Provider Other Organization Name Type Code:
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:
1740353838
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 606
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOORESTOWN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08057-0727
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-234-5304
Provider Business Mailing Address Fax Number:
856-234-5426

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1946 VICTORY BLVD
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:
10314-3520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-420-2220
Provider Business Practice Location Address Fax Number:
718-420-3602
Provider Enumeration Date:
11/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CANINO
Authorized Official First Name:
ANN
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
718-420-2220

Provider Taxonomy Codes

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

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

  • Identifier: 02691647 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com