1245586684 NPI number — VANGUARD MEDICAL IMAGING P C

Table of content: (NPI 1245586684)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245586684 NPI number — VANGUARD MEDICAL IMAGING P C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VANGUARD MEDICAL IMAGING P C
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:
1245586684
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8 CORPORATE CENTER DRIVE
Provider Second Line Business Mailing Address:
105
Provider Business Mailing Address City Name:
MELVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11747-3193
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-396-1050
Provider Business Mailing Address Fax Number:
631-396-0787

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 OLD COUNTRY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLAINVIEW
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11803-6501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-495-5200
Provider Business Practice Location Address Fax Number:
516-495-5201
Provider Enumeration Date:
08/02/2012

Additional Information

Authorized Official

Authorized Official Last Name:
CORRENTE
Authorized Official First Name:
LISA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
516-495-5200

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X , with the licence number:  222791-1 , 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)





Copyright © 2007-2025 www.npivalidator.com