Provider Demographics
NPI:1124414636
Name:DARIUS MELISARATOS, MD, RADIOLOGY, PLLC
Entity Type:Organization
Organization Name:DARIUS MELISARATOS, MD, RADIOLOGY, PLLC
Other - Org Name:PRECISION RADIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARIUS
Authorized Official - Middle Name:P
Authorized Official - Last Name:MELISARATOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-874-8151
Mailing Address - Street 1:345 SEAVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-2244
Mailing Address - Country:US
Mailing Address - Phone:718-980-4888
Mailing Address - Fax:718-980-4873
Practice Address - Street 1:345 SEAVIEW AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-2244
Practice Address - Country:US
Practice Address - Phone:718-980-4888
Practice Address - Fax:718-980-4873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-10
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY180428OtherNY LICENSE REGISTRATION
NY040386OtherMEDICARE PTAN
NYA400132968OtherMEDICARE REASSIGNED PTAN