Provider Demographics
NPI:1578838405
Name:RIVERSIDE RADIOLOGY CONSULTANTS, LLC
Entity Type:Organization
Organization Name:RIVERSIDE RADIOLOGY CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-912-4574
Mailing Address - Street 1:PO BOX 698
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CT
Mailing Address - Zip Code:06878-0698
Mailing Address - Country:US
Mailing Address - Phone:203-912-4574
Mailing Address - Fax:203-724-1891
Practice Address - Street 1:65 HARVARD AVE
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-5564
Practice Address - Country:US
Practice Address - Phone:203-912-4574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-10
Last Update Date:2012-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography