Provider Demographics
NPI:1942503750
Name:RICHMOND IMAGING CORP
Entity Type:Organization
Organization Name:RICHMOND IMAGING CORP
Other - Org Name:RICHMOND IMAGING
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGEMENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAJA
Authorized Official - Suffix:I
Authorized Official - Credentials:01/01/2004
Authorized Official - Phone:917-907-0694
Mailing Address - Street 1:2071 CLOVE RD
Mailing Address - Street 2:P. O. BOX 120278
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-1671
Mailing Address - Country:US
Mailing Address - Phone:718-442-2221
Mailing Address - Fax:
Practice Address - Street 1:2071 CLOVE RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-1671
Practice Address - Country:US
Practice Address - Phone:718-442-2221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RICHMOND IMAGING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-16
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========Medicaid