1578601662 NPI number — MRI ASSOCIATES OF QUEENS, PC

Table of content: (NPI 1578601662)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578601662 NPI number — MRI ASSOCIATES OF QUEENS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MRI ASSOCIATES OF QUEENS, PC
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:
1578601662
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9237 METROPOLITAN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOREST HILLS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11375-6623
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9237 METROPOLITAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOREST HILLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11375-6623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-544-7994
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BUBANY
Authorized Official First Name:
VIKI
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING DIRECTOR
Authorized Official Telephone Number:
718-544-7994

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  147975-1 , 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)

  • Identifier: 1479757 . This is a "WC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: W94551 . This is a "BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 108878 . This is a "NYC HOUSING AUTHORITY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1920243 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 171931 . This is a "ELDERPLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000424112069 . This is a "HEALTH PLUS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02888351 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: ANC038 . This is a "OXFORD CARECORE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0068664 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 106985300 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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