Provider Demographics
NPI:1972786861
Name:PROFESSIONAL DIAGNOSTIC IMAGING II INC
Entity Type:Organization
Organization Name:PROFESSIONAL DIAGNOSTIC IMAGING II INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:CHESNICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-458-9533
Mailing Address - Street 1:641 ARDSLEY PL
Mailing Address - Street 2:
Mailing Address - City:GLENMOORE
Mailing Address - State:PA
Mailing Address - Zip Code:19343-2676
Mailing Address - Country:US
Mailing Address - Phone:610-458-9533
Mailing Address - Fax:610-458-0616
Practice Address - Street 1:641 ARDSLEY PL
Practice Address - Street 2:
Practice Address - City:GLENMOORE
Practice Address - State:PA
Practice Address - Zip Code:19343-2676
Practice Address - Country:US
Practice Address - Phone:610-458-9533
Practice Address - Fax:610-458-0616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD028271E2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C32750Medicare UPIN
099109Medicare PIN