Provider Demographics
NPI:1073590113
Name:PARKLAND DIAGNOSTIC IMAGING, PLLC
Entity Type:Organization
Organization Name:PARKLAND DIAGNOSTIC IMAGING, PLLC
Other - Org Name:PARKLAND DIAGNOSTIC IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR/RADIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:LIEBERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-517-8006
Mailing Address - Street 1:PO BOX 18005
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-8805
Mailing Address - Country:US
Mailing Address - Phone:631-517-8000
Mailing Address - Fax:631-893-1923
Practice Address - Street 1:3055 SOUTHWESTERN BLVD
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1231
Practice Address - Country:US
Practice Address - Phone:716-677-6736
Practice Address - Fax:716-677-6144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-29
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02677205Medicaid
NYDG7385OtherRR MEDICARE PIN
NYAA1402Medicare ID - Type Unspecified