Provider Demographics
NPI:1114185048
Name:CENTRAL NASSAU DIAGNOSTIC IMAGING
Entity Type:Organization
Organization Name:CENTRAL NASSAU DIAGNOSTIC IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTHPEARL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-527-5148
Mailing Address - Street 1:6555 WOODHAVEN BLVD
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-5048
Mailing Address - Country:US
Mailing Address - Phone:718-731-2500
Mailing Address - Fax:718-731-2502
Practice Address - Street 1:6555 WOODHAVEN BLVD
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-5048
Practice Address - Country:US
Practice Address - Phone:718-731-2500
Practice Address - Fax:718-731-2502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1792242085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01626879Medicaid
NYG23864Medicare UPIN