Provider Demographics
NPI:1992193007
Name:ADVANCED RADIOLOGIC CONCEPTS
Entity Type:Organization
Organization Name:ADVANCED RADIOLOGIC CONCEPTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:212-308-3076
Mailing Address - Street 1:2 INDIAN HILL RD
Mailing Address - Street 2:
Mailing Address - City:RYE
Mailing Address - State:NY
Mailing Address - Zip Code:10580-3510
Mailing Address - Country:US
Mailing Address - Phone:212-308-3076
Mailing Address - Fax:
Practice Address - Street 1:211 E 51ST ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-6526
Practice Address - Country:US
Practice Address - Phone:212-308-3076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-26
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2300312085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400035708Medicare PIN
NY635U2JW601Medicare PIN
NYH66267Medicare UPIN