Provider Demographics
NPI:1831459684
Name:PARKWAY IMAGING & DIAGNOSTIC PC
Entity Type:Organization
Organization Name:PARKWAY IMAGING & DIAGNOSTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTHPEARL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-620-9510
Mailing Address - Street 1:400 POST AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-2289
Mailing Address - Country:US
Mailing Address - Phone:516-620-9510
Mailing Address - Fax:
Practice Address - Street 1:450 WAVERLY AVE
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-1555
Practice Address - Country:US
Practice Address - Phone:516-620-9510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-25
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty