Provider Demographics
NPI:1871188995
Name:COMMUNITY RADIOLOGY SERVICE, PC
Entity Type:Organization
Organization Name:COMMUNITY RADIOLOGY SERVICE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MANAGED CARE
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOLGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-495-7129
Mailing Address - Street 1:11302 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6468
Mailing Address - Country:US
Mailing Address - Phone:718-544-3066
Mailing Address - Fax:516-977-2874
Practice Address - Street 1:227 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-1902
Practice Address - Country:US
Practice Address - Phone:516-295-5500
Practice Address - Fax:516-569-8225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty