Provider Demographics
NPI:1669455457
Name:RADIOLOGY OF NEW YORK P.C.
Entity Type:Organization
Organization Name:RADIOLOGY OF NEW YORK P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:OLEKS
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-848-0606
Mailing Address - Street 1:9705 101ST AVE
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11416-2523
Mailing Address - Country:US
Mailing Address - Phone:718-848-0606
Mailing Address - Fax:
Practice Address - Street 1:9705 101ST AVE
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11416-2523
Practice Address - Country:US
Practice Address - Phone:718-848-0606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-25
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2085R0202X
NJ25MA03219200261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02692666Medicaid
NY02692666Medicaid
NY07677Medicare PIN