Provider Demographics
NPI:1124655352
Name:IMAGING SUBSPECIALIST OF NEW YORK
Entity type:Organization
Organization Name:IMAGING SUBSPECIALIST OF NEW YORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAZIANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-407-2044
Mailing Address - Street 1:285 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-5001
Mailing Address - Country:US
Mailing Address - Phone:646-407-2044
Mailing Address - Fax:
Practice Address - Street 1:110 CRYSTAL RUN RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-4040
Practice Address - Country:US
Practice Address - Phone:845-673-6446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-26
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic NeuroimagingGroup - Single Specialty