Provider Demographics
NPI:1417970773
Name:WILLIAMSBURG MEDICAL IMAGING, PC
Entity Type:Organization
Organization Name:WILLIAMSBURG MEDICAL IMAGING, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIAGNOSTIC RADIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-947-2570
Mailing Address - Street 1:762 BEDFORD AVENUE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-1508
Mailing Address - Country:US
Mailing Address - Phone:718-947-2570
Mailing Address - Fax:718-947-2571
Practice Address - Street 1:762 BEDFORD AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-1508
Practice Address - Country:US
Practice Address - Phone:718-947-2570
Practice Address - Fax:718-947-2571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2085R0202X
NY2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100054722OtherMEDICARE PTAN
NY02840944Medicaid
NYA100054722OtherMEDICARE PTAN