Provider Demographics
NPI:1962492546
Name:GOETHALS RADIOLOGY PC
Entity Type:Organization
Organization Name:GOETHALS RADIOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHALOM
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCHBINDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-226-9175
Mailing Address - Street 1:PO BOX 4652
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-0652
Mailing Address - Country:US
Mailing Address - Phone:718-226-9175
Mailing Address - Fax:718-876-3462
Practice Address - Street 1:475 SEAVIEW AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3436
Practice Address - Country:US
Practice Address - Phone:718-226-9175
Practice Address - Fax:718-876-3462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60500062085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3217156OtherAETNA
3C3756OtherHEALTHNET
NY02597262Medicaid
WTE361OtherEMPIRE BC/BS
2318846OtherUHC
4105246OtherGHI
3217156OtherAETNA