Provider Demographics
NPI:1922032150
Name:UNIVERSITY DIAGNOSTIC MEDICAL IMAGING,PC
Entity Type:Organization
Organization Name:UNIVERSITY DIAGNOSTIC MEDICAL IMAGING,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:PRAGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-931-7080
Mailing Address - Street 1:1200 WATERS PL
Mailing Address - Street 2:SUITE M-108
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2728
Mailing Address - Country:US
Mailing Address - Phone:718-931-5620
Mailing Address - Fax:718-824-0706
Practice Address - Street 1:1200 WATERS PL
Practice Address - Street 2:SUITE M-108
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2728
Practice Address - Country:US
Practice Address - Phone:718-931-5620
Practice Address - Fax:718-824-0706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2085B0100X, 2085N0700X, 2085R0204X, 2085U0001X
NY91-3255-012085N0904X, 2085R0203X
NYH90 1185210 83 NY2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Multi-Specialty
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Multi-Specialty
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic RadiologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W12781Medicare ID - Type Unspecified