Provider Demographics
NPI:1912037102
Name:UNION SQUARE MEDICAL IMAGING AND MAMMOGRAPHY PC
Entity Type:Organization
Organization Name:UNION SQUARE MEDICAL IMAGING AND MAMMOGRAPHY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-674-0444
Mailing Address - Street 1:200 PARK AVE S
Mailing Address - Street 2:SUITE 1103
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-1503
Mailing Address - Country:US
Mailing Address - Phone:212-674-0444
Mailing Address - Fax:212-477-4163
Practice Address - Street 1:200 PARK AVE S
Practice Address - Street 2:SUITE 1103
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-1503
Practice Address - Country:US
Practice Address - Phone:212-674-0444
Practice Address - Fax:212-477-4163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200740-1261QR0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY86B35 WEW111Medicare ID - Type Unspecified