Provider Demographics
NPI:1083950281
Name:SPRINGFIELD RADIOLOGY IMAGING PC
Entity Type:Organization
Organization Name:SPRINGFIELD RADIOLOGY IMAGING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:AYOOB
Authorized Official - Middle Name:
Authorized Official - Last Name:KHODADADI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-279-1300
Mailing Address - Street 1:6829 SPRINGFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11364-2632
Mailing Address - Country:US
Mailing Address - Phone:718-279-4200
Mailing Address - Fax:718-279-0020
Practice Address - Street 1:6829 SPRINGFIELD BLVD
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11364-2632
Practice Address - Country:US
Practice Address - Phone:718-279-4200
Practice Address - Fax:718-279-0020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty