Provider Demographics
NPI:1477865558
Name:WESTSIDE RADIOLOGY ASSOCIATES, PC
Entity Type:Organization
Organization Name:WESTSIDE RADIOLOGY ASSOCIATES, PC
Other - Org Name:EAST 95TH STREET RADIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MUNIR
Authorized Official - Middle Name:
Authorized Official - Last Name:GHESANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-523-7049
Mailing Address - Street 1:215 EAST 95TH STREET
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-4077
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 EXCHANGE PLACE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-3918
Practice Address - Country:US
Practice Address - Phone:201-830-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-06
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYH980082307782085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00418960Medicaid
NY00418960Medicaid