Provider Demographics
NPI:1598952707
Name:ATLANTIC RADIOLOGY IMAGING PC
Entity Type:Organization
Organization Name:ATLANTIC RADIOLOGY IMAGING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:
Authorized Official - Last Name:STERN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-236-6800
Mailing Address - Street 1:105 KINGS HWY STE 2M
Mailing Address - Street 2:PO BOX 230156
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-1525
Mailing Address - Country:US
Mailing Address - Phone:718-407-4638
Mailing Address - Fax:
Practice Address - Street 1:105 KINGS HWY STE 2M
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-1525
Practice Address - Country:US
Practice Address - Phone:718-407-4638
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112828174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW9AR31OtherMEDICARE PTAN
NY331769AR31Medicare PIN