Provider Demographics
NPI:1245586684
Name:VANGUARD MEDICAL IMAGING P C
Entity Type:Organization
Organization Name:VANGUARD MEDICAL IMAGING P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CORRENTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-495-5200
Mailing Address - Street 1:8 CORPORATE CENTER DRIVE
Mailing Address - Street 2:105
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-3193
Mailing Address - Country:US
Mailing Address - Phone:631-396-1050
Mailing Address - Fax:631-396-0787
Practice Address - Street 1:520 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-6501
Practice Address - Country:US
Practice Address - Phone:516-495-5200
Practice Address - Fax:516-495-5201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-02
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222791-1261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology