Provider Demographics
NPI:1144393224
Name:RADIOLOGY SERVICES OF NEW YORK, PC
Entity Type:Organization
Organization Name:RADIOLOGY SERVICES OF NEW YORK, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:CANINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-420-2220
Mailing Address - Street 1:PO BOX 606
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-0727
Mailing Address - Country:US
Mailing Address - Phone:856-234-5304
Mailing Address - Fax:856-234-5426
Practice Address - Street 1:348 13TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-5004
Practice Address - Country:US
Practice Address - Phone:718-832-9729
Practice Address - Fax:718-832-9728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02691647Medicaid
NYWEB371Medicare ID - Type Unspecified