1124414636 NPI number — DARIUS MELISARATOS, MD, RADIOLOGY, PLLC

Table of content: (NPI 1124414636)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124414636 NPI number — DARIUS MELISARATOS, MD, RADIOLOGY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DARIUS MELISARATOS, MD, RADIOLOGY, PLLC
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:
PRECISION RADIOLOGY
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:
1124414636
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
345 SEAVIEW AVE
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:
10305-2244
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-980-4888
Provider Business Mailing Address Fax Number:
718-980-4873

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
345 SEAVIEW 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:
10305-2244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-980-4888
Provider Business Practice Location Address Fax Number:
718-980-4873
Provider Enumeration Date:
04/10/2015

Additional Information

Authorized Official

Authorized Official Last Name:
MELISARATOS
Authorized Official First Name:
DARIUS
Authorized Official Middle Name:
P
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
516-874-8151

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: 180428 . This is a "NY LICENSE REGISTRATION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 040386 . This is a "MEDICARE PTAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: A400132968 . This is a "MEDICARE REASSIGNED PTAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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