Provider Demographics
NPI:1265612865
Name:CENTRAL RADIOLOGY SERVICES
Entity type:Organization
Organization Name:CENTRAL RADIOLOGY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTHPEARL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-326-2727
Mailing Address - Street 1:7901 METROPOLITAN AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-2930
Mailing Address - Country:US
Mailing Address - Phone:718-326-2727
Mailing Address - Fax:718-360-9001
Practice Address - Street 1:7901 METROPOLITAN AVE
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-2930
Practice Address - Country:US
Practice Address - Phone:718-326-2727
Practice Address - Fax:718-360-9001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-12
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY179224-4174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05471Medicare PIN