Provider Demographics
NPI:1558313593
Name:EAST MANHATTAN DIAGNOSTIC IMAGING, P.C.
Entity Type:Organization
Organization Name:EAST MANHATTAN DIAGNOSTIC IMAGING, P.C.
Other - Org Name:DOVE OPEN MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MATH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-830-3122
Mailing Address - Street 1:PO BOX 10270
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11555-0270
Mailing Address - Country:US
Mailing Address - Phone:201-830-3122
Mailing Address - Fax:201-200-0838
Practice Address - Street 1:604 2ND AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4859
Practice Address - Country:US
Practice Address - Phone:212-683-6200
Practice Address - Fax:212-683-2992
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST MANHATTAN DIAGNOSTIC IMAGING, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-17
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02459263Medicaid
NYW1L821Medicare PIN