Provider Demographics
NPI:1194973115
Name:ADVANCED RADIOLOGICAL IMAGING ASSOCIATES, P.C.-ASTORIA
Entity type:Organization
Organization Name:ADVANCED RADIOLOGICAL IMAGING ASSOCIATES, P.C.-ASTORIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:D
Authorized Official - Last Name:TARTELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-204-5800
Mailing Address - Street 1:PO BOX 6257
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-0257
Mailing Address - Country:US
Mailing Address - Phone:718-204-4995
Mailing Address - Fax:
Practice Address - Street 1:698 MANHATTAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-3160
Practice Address - Country:US
Practice Address - Phone:718-389-7400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03080279Medicaid
NY03080279Medicaid