Provider Demographics
NPI:1588653638
Name:VIDYA MALHOTRA RADIOLOGY PC
Entity Type:Organization
Organization Name:VIDYA MALHOTRA RADIOLOGY PC
Other - Org Name:MRI-CT SCANNING OF MANHATTAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIDYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALHOTRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-982-1132
Mailing Address - Street 1:1455 BROAD ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-3003
Mailing Address - Country:US
Mailing Address - Phone:973-873-9889
Mailing Address - Fax:973-707-1127
Practice Address - Street 1:195-197 3RD AVE
Practice Address - Street 2:MRI-CT SCANNING OF MANHATTAN
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:212-982-1132
Practice Address - Fax:212-979-2221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01484775Medicaid
NY01484775Medicaid