Provider Demographics
NPI:1578601662
Name:MRI ASSOCIATES OF QUEENS, PC
Entity Type:Organization
Organization Name:MRI ASSOCIATES OF QUEENS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VIKI
Authorized Official - Middle Name:
Authorized Official - Last Name:BUBANY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-544-7994
Mailing Address - Street 1:9237 METROPOLITAN AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6623
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9237 METROPOLITAN AVE
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-6623
Practice Address - Country:US
Practice Address - Phone:718-544-7994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147975-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1479757OtherWC
NYW94551OtherBCBS
NY108878OtherNYC HOUSING AUTHORITY
NY1920243OtherCIGNA
NY171931OtherELDERPLAN
NY000424112069OtherHEALTH PLUS
NY02888351Medicaid
NYANC038OtherOXFORD CARECORE
NY0068664OtherGHI
NY106985300OtherUS DEPT OF LABOR
NY1479757OtherWC
NY=========OtherUHC EMPIRE PLAN
NY000424112069OtherHEALTH PLUS
NY1920243OtherCIGNA
NY0068664OtherGHI
NY=========-006OtherHEALTH FIRST
NY=========OtherOCM
NYANC038OtherOXFORD CARECORE
NY=========-006OtherHEALTH FIRST