1922051630 NPI number — EAST MANHATTAN DIAGNOSTIC IMAGING, P.C.

Table of content: (NPI 1922051630)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922051630 NPI number — EAST MANHATTAN DIAGNOSTIC IMAGING, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST MANHATTAN DIAGNOSTIC 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:
1922051630
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10270
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UNIONDALE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11555-0270
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-830-3122
Provider Business Mailing Address Fax Number:
201-200-0838

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
424 E 89TH ST
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:
10128-6703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-410-5100
Provider Business Practice Location Address Fax Number:
212-410-2500
Provider Enumeration Date:
05/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MATH
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
201-830-3122

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: 5516341 . This is a "FIRSTHEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: NY419 . This is a "ONE CALL MEDICAL" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1425155 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: W1L822 . This is a "EMPIRE BLUE CROSS BLUE SH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4C8838 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: C51294 . This is a "AMERIHEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 03235201 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4199993 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5481603 . This is a "AETNA US HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 959 . This is a "CARECORE NATIONAL" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 189300 . This is a "WELLCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: A3184823 . This is a "OXFORD HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: CD5054 . This is a "PALMETTO GBA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: S23958 . This is a "AMERICAN IMAGING MGNT" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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