Provider Demographics
NPI:1588639553
Name:STAND-UP MRI OF STATEN ISLAND, PC
Entity Type:Organization
Organization Name:STAND-UP MRI OF STATEN ISLAND, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:
Authorized Official - Last Name:WAXMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-694-2816
Mailing Address - Street 1:2090 HYLAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-3457
Mailing Address - Country:US
Mailing Address - Phone:718-351-0616
Mailing Address - Fax:708-351-2417
Practice Address - Street 1:2090 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-3457
Practice Address - Country:US
Practice Address - Phone:718-351-0616
Practice Address - Fax:708-351-2417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02916003Medicaid
NY02916003Medicaid