Provider Demographics
NPI:1023011285
Name:QUEENS MEDICAL IMAGING, PC
Entity Type:Organization
Organization Name:QUEENS MEDICAL IMAGING, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, MANAGED CARE
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:WINAKOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-616-5000
Mailing Address - Street 1:6915 AUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4238
Mailing Address - Country:US
Mailing Address - Phone:718-544-5100
Mailing Address - Fax:718-575-1926
Practice Address - Street 1:6915 AUSTIN ST
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4238
Practice Address - Country:US
Practice Address - Phone:718-544-5100
Practice Address - Fax:718-575-1926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYH980998185782085R0202X
2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02526089Medicaid
NY05211Medicare PIN