Provider Demographics
NPI:1518997204
Name:WYCKOFF IMAGING SERVICES PC
Entity Type:Organization
Organization Name:WYCKOFF IMAGING SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN OF RADIOLOGY DEPARTMENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:
Authorized Official - Last Name:FISCHBEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-907-4970
Mailing Address - Street 1:374 STOCKHOLM ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237-4006
Mailing Address - Country:US
Mailing Address - Phone:718-963-7272
Mailing Address - Fax:
Practice Address - Street 1:374 STOCKHOLM ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-4006
Practice Address - Country:US
Practice Address - Phone:718-963-7373
Practice Address - Fax:718-907-4939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02496582Medicaid
NYWTF111Medicare PIN