Provider Demographics
NPI:1235312141
Name:UNION TOWER RADIOLOGY P.C
Entity Type:Organization
Organization Name:UNION TOWER RADIOLOGY P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTING ASSOCIATE
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-610-3414
Mailing Address - Street 1:142-18 38TH AVENUE
Mailing Address - Street 2:UNIT CF-E
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354
Mailing Address - Country:US
Mailing Address - Phone:718-661-0055
Mailing Address - Fax:718-661-0059
Practice Address - Street 1:142-18 38TH AVENUE
Practice Address - Street 2:UNIT CF-E
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354
Practice Address - Country:US
Practice Address - Phone:718-661-0055
Practice Address - Fax:718-661-0059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1602411247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01697290Medicaid
NYE71149Medicare UPIN