Provider Demographics
NPI:1417367921
Name:NEW YORK RADIOLOGY PC
Entity type:Organization
Organization Name:NEW YORK RADIOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAIYER
Authorized Official - Middle Name:
Authorized Official - Last Name:IMAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-412-9990
Mailing Address - Street 1:5718 JUNCTION BLVD
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-5153
Mailing Address - Country:US
Mailing Address - Phone:718-412-9990
Mailing Address - Fax:718-412-9991
Practice Address - Street 1:5718 JUNCTION BLVD
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5153
Practice Address - Country:US
Practice Address - Phone:718-412-9990
Practice Address - Fax:718-412-9991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-06
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2248612085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty