Provider Demographics
NPI:1568456747
Name:NORTH SHORE REGIONAL MRI PC
Entity Type:Organization
Organization Name:NORTH SHORE REGIONAL MRI PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTONACCI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-588-4500
Mailing Address - Street 1:2780 MIDDLE COUNTRY ROAD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:LAKE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:11755
Mailing Address - Country:US
Mailing Address - Phone:631-588-4500
Mailing Address - Fax:631-588-4595
Practice Address - Street 1:2780 MIDDLE COUNTRY ROAD
Practice Address - Street 2:SUITE 305
Practice Address - City:LAKE GROVE
Practice Address - State:NY
Practice Address - Zip Code:11755
Practice Address - Country:US
Practice Address - Phone:631-689-5252
Practice Address - Fax:631-689-5934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-02
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Multi-Specialty