Provider Demographics
NPI:1962573592
Name:MEADOWS NUCLEAR SPECT IMAGING, PC
Entity type:Organization
Organization Name:MEADOWS NUCLEAR SPECT IMAGING, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, MANAGED CARE & CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-952-5717
Mailing Address - Street 1:PO BOX 13116
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-0556
Mailing Address - Country:US
Mailing Address - Phone:631-979-1699
Mailing Address - Fax:631-979-1667
Practice Address - Street 1:496 SMITHTOWN BYP
Practice Address - Street 2:SUITE 206
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-5005
Practice Address - Country:US
Practice Address - Phone:631-979-1699
Practice Address - Fax:631-979-1667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02082653Medicaid
NY02082653Medicaid