Provider Demographics
NPI:1891845921
Name:CROSS BAY OPEN IMAGING MDS PC
Entity Type:Organization
Organization Name:CROSS BAY OPEN IMAGING MDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:P
Authorized Official - Last Name:DRUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-763-2735
Mailing Address - Street 1:15636 CROSSBAY BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-2700
Mailing Address - Country:US
Mailing Address - Phone:718-738-0700
Mailing Address - Fax:718-738-4177
Practice Address - Street 1:15636 CROSSBAY BLVD STE A
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-2700
Practice Address - Country:US
Practice Address - Phone:718-738-0700
Practice Address - Fax:718-738-4177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1428122085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01420Medicare ID - Type UnspecifiedGROUP #