Provider Demographics
NPI:1114046950
Name:RICHMOND RADIOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:RICHMOND RADIOLOGY ASSOCIATES
Other - Org Name:RICHMOND IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:DENISE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-442-2221
Mailing Address - Street 1:2071 CLOVE ROAD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304
Mailing Address - Country:US
Mailing Address - Phone:718-442-2221
Mailing Address - Fax:718-447-8183
Practice Address - Street 1:2071 CLOVE ROAD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304
Practice Address - Country:US
Practice Address - Phone:718-442-2221
Practice Address - Fax:718-447-8183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYH98106708578174400000X
NY1574282085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA63280Medicare UPIN
NYWT7591Medicare ID - Type Unspecified
NYA300000392Medicare PIN