Provider Demographics
NPI:1962772301
Name:TOTAL RADIOLOGY, PC
Entity type:Organization
Organization Name:TOTAL RADIOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SIDDHARTH
Authorized Official - Middle Name:
Authorized Official - Last Name:PRAKASH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-346-8330
Mailing Address - Street 1:3199 BAINBRIDGE AVE
Mailing Address - Street 2:1ST FL
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-3907
Mailing Address - Country:US
Mailing Address - Phone:347-346-8330
Mailing Address - Fax:347-346-8333
Practice Address - Street 1:3199 BAINBRIDGE AVE
Practice Address - Street 2:1ST FL
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-3907
Practice Address - Country:US
Practice Address - Phone:347-346-8330
Practice Address - Fax:347-346-8333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-03
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03412475Medicaid
NY03412475Medicaid