Provider Demographics
NPI:1356538201
Name:STOCKTON DIAGNOSTIC IMAGING
Entity type:Organization
Organization Name:STOCKTON DIAGNOSTIC IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-445-2800
Mailing Address - Street 1:1160 PITTSFORD VICTOR RD
Mailing Address - Street 2:D-2
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-3825
Mailing Address - Country:US
Mailing Address - Phone:585-218-8007
Mailing Address - Fax:585-218-8009
Practice Address - Street 1:1801 E MARCH LN STE A130
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-6650
Practice Address - Country:US
Practice Address - Phone:209-475-9871
Practice Address - Fax:209-474-9620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ04647ZMedicare PIN