Provider Demographics
NPI:1720329048
Name:JR MEDICAL DIAGNOSTIC PC
Entity type:Organization
Organization Name:JR MEDICAL DIAGNOSTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:RIGNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-564-5300
Mailing Address - Street 1:5 JEANNE DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-1798
Mailing Address - Country:US
Mailing Address - Phone:845-564-5300
Mailing Address - Fax:845-564-5301
Practice Address - Street 1:5 JEANNE DR
Practice Address - Street 2:SUITE 5
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-1798
Practice Address - Country:US
Practice Address - Phone:845-564-5300
Practice Address - Fax:845-564-5301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1565032085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY156503OtherLICENSE