Provider Demographics
NPI:1114189735
Name:NUTAN ANAND PHYSICIAN PC
Entity Type:Organization
Organization Name:NUTAN ANAND PHYSICIAN PC
Other - Org Name:LONG ISLAND DIAGNOSTIC IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AZAD
Authorized Official - Middle Name:K
Authorized Official - Last Name:ANAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-689-7300
Mailing Address - Street 1:PO BOX 63
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-0063
Mailing Address - Country:US
Mailing Address - Phone:631-689-7300
Mailing Address - Fax:631-689-7321
Practice Address - Street 1:205 OSBORNE AVE
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-3021
Practice Address - Country:US
Practice Address - Phone:631-727-6025
Practice Address - Fax:631-727-6044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1380792085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00571857Medicaid
NY1821124512OtherINDIVIDUAL NPI
NY211029OtherSECOND SITE FDA
NY1548201353OtherINDIVIDUAL NPI
NY1689700403OtherNPI #
NY1902838816OtherINDIVIDUAL NPI
NY51014000OtherNYS DEPARTMENT OF HEALTH RADIATION CERTIFICATION
NY120964OtherFDA #
NY1679609457OtherINDIVIDUAL NPI
NY167312OtherFDA NUMBER
NY51014000OtherNYS DEPARTMENT OF HEALTH RADIATION CERTIFICATION
NYB80409Medicare UPIN
NY1821124512OtherINDIVIDUAL NPI
NY167312OtherFDA NUMBER
NY46A403Medicare PIN