1033125844 NPI number — RADIOLOGIC ASSOCIATES PROF CORP

Table of content: (NPI 1033125844)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033125844 NPI number — RADIOLOGIC ASSOCIATES PROF CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RADIOLOGIC ASSOCIATES PROF CORP
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:
RADIOLOGIC ASSOCIATES PC
Provider Other Organization Name Type Code:
5
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:
1033125844
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
185 RYKOWSKI LN STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLETOWN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10941-4055
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-692-0030
Provider Business Mailing Address Fax Number:
845-692-0037

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
707 E MAIN ST
Provider Second Line Business Practice Location Address:
RADIOLOGIC ASSOCIATES
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10940-2650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-343-0616
Provider Business Practice Location Address Fax Number:
845-343-0617
Provider Enumeration Date:
08/01/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RACANELLI
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
LOUIS
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
845-692-0030

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085N0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085N0904X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085P0229X ; 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: "Y" .
  • Taxonomy code: 2085R0204X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085U0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 00580727 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 018324000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".