| NPI | 1518077197 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACKIE ST. JOHN Contracting & Credentialing 631-930-5215 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2013-03-15 |