Provider Demographics
NPI:1629053566
Name:GREENE MEDICAL IMAGING PC
Entity Type:Organization
Organization Name:GREENE MEDICAL IMAGING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHANTILAL
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-943-0212
Mailing Address - Street 1:PO BOX 1362
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-8862
Mailing Address - Country:US
Mailing Address - Phone:800-357-4829
Mailing Address - Fax:518-786-1293
Practice Address - Street 1:159 JEFFERSON HTS
Practice Address - Street 2:
Practice Address - City:CATSKILL
Practice Address - State:NY
Practice Address - Zip Code:12414-1237
Practice Address - Country:US
Practice Address - Phone:518-943-0212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW25021Medicare ID - Type Unspecified