Provider Demographics
NPI:1275930489
Name:FRESH MEADOWS DIAGNOSTIC RADIOLOGY, PC
Entity Type:Organization
Organization Name:FRESH MEADOWS DIAGNOSTIC RADIOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:LEONARD
Authorized Official - Last Name:LEFKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-359-8700
Mailing Address - Street 1:16105 HORACE HARDING EXPY
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11365-1426
Mailing Address - Country:US
Mailing Address - Phone:718-359-8700
Mailing Address - Fax:718-762-0067
Practice Address - Street 1:16105 HORACE HARDING EXPY
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11365-1426
Practice Address - Country:US
Practice Address - Phone:718-359-8700
Practice Address - Fax:718-762-0067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-03
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106140-4261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00186118Medicaid
NY711291Medicare PIN
NY00186118Medicaid