Provider Demographics
NPI:1538117379
Name:ADVANCED RADIOLOGICAL PET IMAGING, P.C.
Entity Type:Organization
Organization Name:ADVANCED RADIOLOGICAL PET IMAGING, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:TARTELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-204-5800
Mailing Address - Street 1:PO BOX 2002
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-4502
Mailing Address - Country:US
Mailing Address - Phone:315-362-5285
Mailing Address - Fax:315-362-2936
Practice Address - Street 1:2334 30TH AVE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-3281
Practice Address - Country:US
Practice Address - Phone:718-204-7774
Practice Address - Fax:718-204-6967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02442648Medicaid
NY05677Medicare PIN