Provider Demographics
NPI:1619943495
Name:ISLAND DIAGNOSTIC IMAGING ASSOCIATES
Entity Type:Organization
Organization Name:ISLAND DIAGNOSTIC IMAGING ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:PEYSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-797-6700
Mailing Address - Street 1:4160 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758
Mailing Address - Country:US
Mailing Address - Phone:516-797-6700
Mailing Address - Fax:516-797-8463
Practice Address - Street 1:4160 MERRICK RD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758
Practice Address - Country:US
Practice Address - Phone:516-797-6700
Practice Address - Fax:516-797-8463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-23
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY29022743261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02255443Medicaid
NYW95022Medicare ID - Type Unspecified