Provider Demographics
NPI:1487646311
Name:GREAT NECK IMAGING
Entity Type:Organization
Organization Name:GREAT NECK IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:FAGELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-829-3557
Mailing Address - Street 1:907 NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5304
Mailing Address - Country:US
Mailing Address - Phone:516-829-3557
Mailing Address - Fax:516-829-5286
Practice Address - Street 1:907 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5304
Practice Address - Country:US
Practice Address - Phone:516-829-3557
Practice Address - Fax:516-829-5286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW5J401Medicare ID - Type Unspecified