Provider Demographics
NPI:1518077197
Name:PROFESSIONAL IMAGING CONSULTANTS, PC
Entity Type:Organization
Organization Name:PROFESSIONAL IMAGING CONSULTANTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTING & CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ST. JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-930-5215
Mailing Address - Street 1:500 W MAIN ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-3027
Mailing Address - Country:US
Mailing Address - Phone:631-930-5215
Mailing Address - Fax:631-517-8007
Practice Address - Street 1:3614 VICTORIA AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-2208
Practice Address - Country:US
Practice Address - Phone:618-315-6058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty