Provider Demographics
NPI:1649561291
Name:DRA IMAGING, PC
Entity Type:Organization
Organization Name:DRA IMAGING, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:FRIEDLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-454-4700
Mailing Address - Street 1:169 MYERS CORNERS RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-3867
Mailing Address - Country:US
Mailing Address - Phone:845-454-4700
Mailing Address - Fax:845-790-5719
Practice Address - Street 1:400 WESTAGE BUSINESS CTR DR
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-2223
Practice Address - Country:US
Practice Address - Phone:845-454-4700
Practice Address - Fax:845-790-5719
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DRA IMAGING, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-29
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00424951Medicaid
NY00424951Medicaid