Provider Demographics
NPI:1265529101
Name:RADIOLOGY ASSOCIATES OF MAIN STREET PC
Entity type:Organization
Organization Name:RADIOLOGY ASSOCIATES OF MAIN STREET PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ARI
Authorized Official - Middle Name:
Authorized Official - Last Name:JONISCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-428-1500
Mailing Address - Street 1:3211 FRANCIS LEWIS BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-1922
Mailing Address - Country:US
Mailing Address - Phone:718-352-9850
Mailing Address - Fax:718-352-0102
Practice Address - Street 1:5645 MAIN ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5045
Practice Address - Country:US
Practice Address - Phone:718-670-1050
Practice Address - Fax:718-670-1901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01791762Medicaid
NY01791762Medicaid