Provider Demographics
NPI:1053303909
Name:ADVANCED MEDICAL IMAGING OF LONG ISLAND PC
Entity Type:Organization
Organization Name:ADVANCED MEDICAL IMAGING OF LONG ISLAND PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:FAGELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-482-6700
Mailing Address - Street 1:900 NORTHERN BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5302
Mailing Address - Country:US
Mailing Address - Phone:516-482-6700
Mailing Address - Fax:
Practice Address - Street 1:900 NORTHERN BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5302
Practice Address - Country:US
Practice Address - Phone:516-482-6700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-17
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
NYW21891Medicare ID - Type Unspecified