Provider Demographics
NPI:1821381633
Name:SLR DIAGNOSTIC RADIOLOGY, PC
Entity Type:Organization
Organization Name:SLR DIAGNOSTIC RADIOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-523-4272
Mailing Address - Street 1:1090 AMSTERDAM AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-1737
Mailing Address - Country:US
Mailing Address - Phone:212-590-2900
Mailing Address - Fax:
Practice Address - Street 1:1090 AMSTERDAM AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-1737
Practice Address - Country:US
Practice Address - Phone:212-590-2900
Practice Address - Fax:212-523-4857
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SLR DIAGNOSTIC RADIOLOGY, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY413917472085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherEIN