Provider Demographics
NPI:1922551027
Name:FULL FRAME RADIOLOGY & DIAGNOSTIC IMAGING GROUP PLLC
Entity Type:Organization
Organization Name:FULL FRAME RADIOLOGY & DIAGNOSTIC IMAGING GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:W
Authorized Official - Last Name:QIU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-693-1312
Mailing Address - Street 1:PO BOX 270
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-0270
Mailing Address - Country:US
Mailing Address - Phone:631-264-2035
Mailing Address - Fax:631-264-1418
Practice Address - Street 1:13237 POPLE AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-4448
Practice Address - Country:US
Practice Address - Phone:732-693-1312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty