Provider Demographics
NPI:1154982361
Name:EAST RIVER DIAGNOSTIC CENTER LLC
Entity type:Organization
Organization Name:EAST RIVER DIAGNOSTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:
Authorized Official - Last Name:FUSARO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:516-410-3640
Mailing Address - Street 1:48 LEONARD DR
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-7920
Mailing Address - Country:US
Mailing Address - Phone:212-288-2823
Mailing Address - Fax:212-208-4648
Practice Address - Street 1:3 FRANKLIN PL
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-7016
Practice Address - Country:US
Practice Address - Phone:516-410-3640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-27
Last Update Date:2022-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Single Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty