Provider Demographics
NPI:1265794853
Name:PARK PLACE MEDICAL IMAGING P.C.
Entity type:Organization
Organization Name:PARK PLACE MEDICAL IMAGING P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CORRENTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-380-2075
Mailing Address - Street 1:101 W 24TH ST
Mailing Address - Street 2:APT 28H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-1909
Mailing Address - Country:US
Mailing Address - Phone:212-380-2075
Mailing Address - Fax:212-380-2076
Practice Address - Street 1:316 E 30TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-8366
Practice Address - Country:US
Practice Address - Phone:212-380-2075
Practice Address - Fax:212-380-2076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-11
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)