Provider Demographics
NPI:1033103668
Name:WESTCHESTER SQUARE IMAGING ASSOCIATES PC
Entity Type:Organization
Organization Name:WESTCHESTER SQUARE IMAGING ASSOCIATES PC
Other - Org Name:WESTCHESTER SQUARE IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:N
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-931-6525
Mailing Address - Street 1:1455 BROAD ST
Mailing Address - Street 2:4TH FLOOR WESTCHESTER SQUARE IMAGING ASSOCIATES PC
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-3003
Mailing Address - Country:US
Mailing Address - Phone:973-873-9889
Mailing Address - Fax:973-707-1127
Practice Address - Street 1:2475 SAINT RAYMONDS AVE
Practice Address - Street 2:WESTCHESTER SQUARE IMAGING CENTER
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3124
Practice Address - Country:US
Practice Address - Phone:718-931-6525
Practice Address - Fax:718-931-6525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW0E041Medicare ID - Type Unspecified