Provider Demographics
NPI:1245217298
Name:HIGHWAY IMAGING ASSOCIATES
Entity Type:Organization
Organization Name:HIGHWAY IMAGING ASSOCIATES
Other - Org Name:HIGHWAY IMAGING ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERLLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-338-6868
Mailing Address - Street 1:PO BOX 18005
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-8805
Mailing Address - Country:US
Mailing Address - Phone:631-517-8000
Mailing Address - Fax:631-893-1923
Practice Address - Street 1:2095 FLATBUSH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-4338
Practice Address - Country:US
Practice Address - Phone:718-338-6868
Practice Address - Fax:718-252-3650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-29
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01800742Medicaid
NYCL0568OtherRAILROAD MEDICARE
NYW10671Medicare ID - Type Unspecified