Provider Demographics
NPI:1821161811
Name:ROCKVILLE PET IMAGING PC
Entity Type:Organization
Organization Name:ROCKVILLE PET IMAGING PC
Other - Org Name:LUCILLE P. TAVERNA-GIARDINA
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUCILLE
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:TAVERNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-255-9555
Mailing Address - Street 1:119 N PARK AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-4113
Mailing Address - Country:US
Mailing Address - Phone:516-255-9555
Mailing Address - Fax:516-255-9444
Practice Address - Street 1:119 N PARK AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-4113
Practice Address - Country:US
Practice Address - Phone:516-255-9555
Practice Address - Fax:516-255-9444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11247412085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00380218Medicaid
NYWTC601Medicare ID - Type Unspecified
NY00380218Medicaid