Provider Demographics
NPI:1003987439
Name:NEW YORK HOME X-RAY LLC
Entity Type:Organization
Organization Name:NEW YORK HOME X-RAY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:M
Authorized Official - Last Name:DALY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-590-3331
Mailing Address - Street 1:527 ROUTE 22 STE 4
Mailing Address - Street 2:
Mailing Address - City:PAWLING
Mailing Address - State:NY
Mailing Address - Zip Code:12564-1218
Mailing Address - Country:US
Mailing Address - Phone:845-289-0103
Mailing Address - Fax:845-855-1010
Practice Address - Street 1:527 ROUTE 22 STE 4
Practice Address - Street 2:
Practice Address - City:PAWLING
Practice Address - State:NY
Practice Address - Zip Code:12564-1218
Practice Address - Country:US
Practice Address - Phone:845-289-0103
Practice Address - Fax:845-855-1010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY923491247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02703024Medicaid
NYP00354489Medicare ID - Type UnspecifiedRAILROAD MEDICARE
NY02703024Medicaid
NYO97081Medicare ID - Type UnspecifiedNY MEDICARE EMPIRE