Provider Demographics
NPI:1508816166
Name:SUBURBAN MEDICAL IMAGING PC
Entity Type:Organization
Organization Name:SUBURBAN MEDICAL IMAGING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANET
Authorized Official - Middle Name:H
Authorized Official - Last Name:SUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-631-2500
Mailing Address - Street 1:55 SPINDRIFT DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7800
Mailing Address - Country:US
Mailing Address - Phone:716-631-2500
Mailing Address - Fax:716-631-1249
Practice Address - Street 1:3950 E ROBINSON RD
Practice Address - Street 2:
Practice Address - City:WEST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-2041
Practice Address - Country:US
Practice Address - Phone:716-633-2880
Practice Address - Fax:716-631-1249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4199862OtherGHI PROVIDER NUMBER
NY01743553Medicaid
NM14312AMedicare ID - Type UnspecifiedMCR GRP PROVIDER NUMBER