Provider Demographics
NPI:1376545012
Name:CENTRAL RADIOLOGY, PC
Entity Type:Organization
Organization Name:CENTRAL RADIOLOGY, PC
Other - Org Name:FLUSHING IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY X.
Authorized Official - Middle Name:
Authorized Official - Last Name:HU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-888-9180
Mailing Address - Street 1:13710 NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4122
Mailing Address - Country:US
Mailing Address - Phone:718-888-9180
Mailing Address - Fax:718-888-9260
Practice Address - Street 1:13710 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4122
Practice Address - Country:US
Practice Address - Phone:718-888-9180
Practice Address - Fax:718-888-9260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-12
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02427627Medicaid
NY02427627Medicaid
NY05757Medicare PIN