Provider Demographics
NPI:1548396203
Name:NUTAN ANAND, MD, PC
Entity Type:Organization
Organization Name:NUTAN ANAND, MD, PC
Other - Org Name:LONG ISLAND DIAGNOSTIC IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-364-4600
Mailing Address - Street 1:100 LAFAYETTE DR
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-3934
Mailing Address - Country:US
Mailing Address - Phone:516-364-4600
Mailing Address - Fax:516-364-4690
Practice Address - Street 1:205 OSBORNE AVE
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-3021
Practice Address - Country:US
Practice Address - Phone:631-727-6025
Practice Address - Fax:631-727-6025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY510218872085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY51021887OtherNYSDOH CERTIFICATION
NY211029OtherFDA CERTIFICATION
NY1902838816OtherINDIVIDUAL NPI