Provider Demographics
NPI:1427411735
Name:UNION SQUARE RADIOLOGY P.C.
Entity Type:Organization
Organization Name:UNION SQUARE RADIOLOGY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-674-0444
Mailing Address - Street 1:200 PARK AVE S
Mailing Address - Street 2:SUITE 1103
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-1503
Mailing Address - Country:US
Mailing Address - Phone:212-674-0444
Mailing Address - Fax:
Practice Address - Street 1:247 3RD AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-7457
Practice Address - Country:US
Practice Address - Phone:212-674-0444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-04
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY277403207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1922106Medicaid
NJ1922106Medicaid