Provider Demographics
NPI:1356492490
Name:DRUCKER GENUTH AUGENSTEIN & KASOW MDS PC
Entity Type:Organization
Organization Name:DRUCKER GENUTH AUGENSTEIN & KASOW MDS PC
Other - Org Name:SOUTH SHORE RADIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:P
Authorized Official - Last Name:DRUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-763-2735
Mailing Address - Street 1:PO BOX 9010
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11571-9010
Mailing Address - Country:US
Mailing Address - Phone:516-763-2735
Mailing Address - Fax:516-763-2738
Practice Address - Street 1:650 MERRICK RD
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-3501
Practice Address - Country:US
Practice Address - Phone:516-377-2175
Practice Address - Fax:516-377-2545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1428122085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW15902Medicare ID - Type UnspecifiedGROUP #