Provider Demographics
NPI:1083659379
Name:PERSONAL HEALTH IMAGING, PLLC
Entity Type:Organization
Organization Name:PERSONAL HEALTH IMAGING, PLLC
Other - Org Name:ALLIUM DIAGNOSTIC IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:CARLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-353-0400
Mailing Address - Street 1:PO BOX 1928
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12201-1928
Mailing Address - Country:US
Mailing Address - Phone:845-353-0400
Mailing Address - Fax:
Practice Address - Street 1:260 N ROUTE 303
Practice Address - Street 2:
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-1608
Practice Address - Country:US
Practice Address - Phone:845-353-0400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY43502174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02500521Medicaid
NY02500521Medicaid