Provider Demographics
NPI:1609227479
Name:PREEMPTIVE RADIOLOGICAL IMAGING, P.C.
Entity Type:Organization
Organization Name:PREEMPTIVE RADIOLOGICAL IMAGING, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLANCY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-343-4373
Mailing Address - Street 1:PO BOX 13023
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-0535
Mailing Address - Country:US
Mailing Address - Phone:631-343-4373
Mailing Address - Fax:877-590-0289
Practice Address - Street 1:2171 JERICHO TPKE
Practice Address - Street 2:SUITE 100-B
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-2937
Practice Address - Country:US
Practice Address - Phone:631-343-4373
Practice Address - Fax:877-590-0289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-23
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY116260-5207RC0000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty