Provider Demographics
NPI:1619416229
Name:THIRD AVENUE IMAGING LLC
Entity Type:Organization
Organization Name:THIRD AVENUE IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:REISMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-742-0700
Mailing Address - Street 1:2781 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10455-4002
Mailing Address - Country:US
Mailing Address - Phone:718-742-0700
Mailing Address - Fax:
Practice Address - Street 1:2781 3RD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-4002
Practice Address - Country:US
Practice Address - Phone:718-742-0700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY161093261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)