1982712683 NPI number — RAPID PORTABLE X-RAY SERVICE INC

Table of content: CAROLINE ELAINE RUCKER (NPI 1043930563)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982712683 NPI number — RAPID PORTABLE X-RAY SERVICE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAPID PORTABLE X-RAY SERVICE INC
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:
1982712683
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6851 JERICHO TPKE STE 150
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:
11791-4462
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-986-2700
Provider Business Mailing Address Fax Number:
516-986-2710

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6851 JERICHO TPKE STE 150
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYOSSET
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11791-4462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-986-2700
Provider Business Practice Location Address Fax Number:
516-986-2710
Provider Enumeration Date:
08/25/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SEADER
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
BARRY
Authorized Official Title or Position:
SECRETARY TREASURER
Authorized Official Telephone Number:
516-986-2700

Provider Taxonomy Codes

  • Taxonomy code: 261QR0208X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335V00000X , with the licence number: 29014184 , 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: 870022100 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01867514 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".