Provider Demographics
NPI:1073788188
Name:LONG ISLAND MEDICAL IMAGING, PC
Entity Type:Organization
Organization Name:LONG ISLAND MEDICAL IMAGING, PC
Other - Org Name:ZILKHA RADIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:ZILKHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-277-1600
Mailing Address - Street 1:1161 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4930
Mailing Address - Country:US
Mailing Address - Phone:631-277-1600
Mailing Address - Fax:631-277-1638
Practice Address - Street 1:1161 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4930
Practice Address - Country:US
Practice Address - Phone:631-277-1600
Practice Address - Fax:631-277-1638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02925735Medicaid
NY02925735Medicaid