Provider Demographics
NPI:1083964712
Name:ENTERPRISE RADIOLOGY PC
Entity Type:Organization
Organization Name:ENTERPRISE RADIOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:BEYDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-495-7115
Mailing Address - Street 1:545 ELMONT RD
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-4002
Mailing Address - Country:US
Mailing Address - Phone:516-354-4200
Mailing Address - Fax:516-495-7129
Practice Address - Street 1:4334 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-2412
Practice Address - Country:US
Practice Address - Phone:516-495-7129
Practice Address - Fax:516-977-2874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2195432085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty