| NPI | 1811903578 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY DELLACERRA VP Managed Care & Revenue Complianc 718-630-7103 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 16820) |
| Additional Taxonomies | 2085U0001X Radiology, Diagnostic Ultrasound (Licence: NY 16820) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 16820) | |
| 2085N0904X Radiology, Nuclear Radiology (Licence: NY 16820) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2008-09-08 |