Provider Demographics
NPI:1033315536
Name:DELTA RADIOLOGY & IMAGING P.C.
Entity Type:Organization
Organization Name:DELTA RADIOLOGY & IMAGING P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:SHERRY
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-648-4646
Mailing Address - Street 1:2647 CONEY ISLAND AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-5502
Mailing Address - Country:US
Mailing Address - Phone:718-648-4646
Mailing Address - Fax:718-368-1177
Practice Address - Street 1:2647 CONEY ISLAND AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-5502
Practice Address - Country:US
Practice Address - Phone:718-648-4646
Practice Address - Fax:718-368-1177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01496015Medicaid
NYE41926Medicare UPIN
NYWTH121Medicare ID - Type UnspecifiedGROUP ID