Provider Demographics
NPI:1568828861
Name:STAND-UP MRI OF EAST ELMHURST, P.C.
Entity Type:Organization
Organization Name:STAND-UP MRI OF EAST ELMHURST, P.C.
Other - Org Name:STAND-UP MRI OF GREAT NECK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:M
Authorized Official - Last Name:TICE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-694-2929
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-0127
Mailing Address - Country:US
Mailing Address - Phone:631-694-2816
Mailing Address - Fax:
Practice Address - Street 1:600 NORTHERN BLVD
Practice Address - Street 2:SUITE 117
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5206
Practice Address - Country:US
Practice Address - Phone:516-478-0004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-04
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology