Provider Demographics
NPI:1083871248
Name:STAT PORTABLE X-RAY INC
Entity Type:Organization
Organization Name:STAT PORTABLE X-RAY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:PLATSCHEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-217-8000
Mailing Address - Street 1:21118 UNION TPKE
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11364-3241
Mailing Address - Country:US
Mailing Address - Phone:718-217-8000
Mailing Address - Fax:718-217-5485
Practice Address - Street 1:21118 UNION TPKE
Practice Address - Street 2:
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-3241
Practice Address - Country:US
Practice Address - Phone:718-217-8000
Practice Address - Fax:718-217-5485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYH981204506 76246X00000X
NYH981204506762471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Multi-Specialty
No246X00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03320Medicare PIN
NY97Z261Medicare PIN