Provider Demographics
NPI:1720031339
Name:DOSHI DIAGNOSTIC IMAGING SERVICES PC
Entity Type:Organization
Organization Name:DOSHI DIAGNOSTIC IMAGING SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:TYLUTKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-933-2800
Mailing Address - Street 1:P.O. BOX 129
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:NY
Mailing Address - Zip Code:11948-0129
Mailing Address - Country:US
Mailing Address - Phone:516-937-2233
Mailing Address - Fax:516-822-4167
Practice Address - Street 1:560 SOUTH BROADWAY
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-5027
Practice Address - Country:US
Practice Address - Phone:516-937-2233
Practice Address - Fax:516-822-4167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2085R0202X
2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01806495Medicaid
NYW30661Medicare ID - Type UnspecifiedEMPIRE MCR
NY84286Medicare ID - Type UnspecifiedGHI MEDICARE