Provider Demographics
NPI:1508185646
Name:SLR DIAGNOSTIC RADIOLOGY, PC
Entity Type:Organization
Organization Name:SLR DIAGNOSTIC RADIOLOGY, PC
Other - Org Name:BETH ISRAEL COMPREHENSIVE CANCER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-830-3122
Mailing Address - Street 1:10 EXCHANGE PL
Mailing Address - Street 2:14TH FLOOR
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-3918
Mailing Address - Country:US
Mailing Address - Phone:201-830-3200
Mailing Address - Fax:201-200-0838
Practice Address - Street 1:325 WEST 15TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-5903
Practice Address - Country:US
Practice Address - Phone:212-604-6000
Practice Address - Fax:201-604-6002
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SLR DIAGNOSTIC RADIOLOGY, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-28
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01002042Medicaid
NY01002042Medicaid