Provider Demographics
NPI:1467172676
Name:STAND-UP MRI OF EAST ELMHURST, P.C.
Entity Type:Organization
Organization Name:STAND-UP MRI OF EAST ELMHURST, P.C.
Other - Org Name:DBA: STAND-UP MRI OF THE SOUTH BRONX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:M
Authorized Official - Last Name:TICE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-694-2929
Mailing Address - Street 1:110 MARCUS DRIVE
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-4227
Mailing Address - Country:US
Mailing Address - Phone:631-390-1793
Mailing Address - Fax:631-390-1780
Practice Address - Street 1:618 MORRIS AVENUE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451
Practice Address - Country:US
Practice Address - Phone:718-540-6898
Practice Address - Fax:718-540-6899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-29
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology