Provider Demographics
NPI:1336214139
Name:FOREST HILLS NUCLEAR SPECT IMAGING PC
Entity Type:Organization
Organization Name:FOREST HILLS NUCLEAR SPECT IMAGING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP MANAGED CARE & CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-952-5717
Mailing Address - Street 1:PO BOX 13065
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-0546
Mailing Address - Country:US
Mailing Address - Phone:718-459-2800
Mailing Address - Fax:718-459-3027
Practice Address - Street 1:6915 AUSTIN ST
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4238
Practice Address - Country:US
Practice Address - Phone:718-459-2800
Practice Address - Fax:718-459-3027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02082906Medicaid
NY02082906Medicaid