Provider Demographics
NPI:1740536044
Name:RADIOLOGY MEDICAL ASSOCIATES PC
Entity type:Organization
Organization Name:RADIOLOGY MEDICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:
Authorized Official - Last Name:LISANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-730-4606
Mailing Address - Street 1:6923 168TH STREET
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-3213
Mailing Address - Country:US
Mailing Address - Phone:718-539-3646
Mailing Address - Fax:888-500-0406
Practice Address - Street 1:97-28 63RD ROAD
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1639
Practice Address - Country:US
Practice Address - Phone:718-539-3646
Practice Address - Fax:888-500-0406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-24
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261994-12085R0202X
2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty