1366770869 NPI number — DIAGNOSTIC MR IMAGING, P.C.

Table of content: (NPI 1366770869)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366770869 NPI number — DIAGNOSTIC MR IMAGING, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIAGNOSTIC MR 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:
6
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:
1366770869
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5000 BROADWAY SUITE 1D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-567-5191
Provider Business Mailing Address Fax Number:
212-567-5093

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5000 BROADWAY SUITE 1D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-567-5191
Provider Business Practice Location Address Fax Number:
212-567-5093
Provider Enumeration Date:
11/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
RIGNEY
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
T.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
212-567-5191

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00901271 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 49D31 . This is a "MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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