Provider Demographics
NPI:1508049735
Name:ADVANTAGE RADIOLOGY. PC
Entity Type:Organization
Organization Name:ADVANTAGE RADIOLOGY. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWENER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:B
Authorized Official - Last Name:LOSIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-648-5858
Mailing Address - Street 1:3049 OCEAN PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-8372
Mailing Address - Country:US
Mailing Address - Phone:718-265-1000
Mailing Address - Fax:718-265-1002
Practice Address - Street 1:3049 OCEAN PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-8302
Practice Address - Country:US
Practice Address - Phone:718-648-5858
Practice Address - Fax:718-375-2735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2263202085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02361291Medicaid
NY02361291Medicaid