Provider Demographics
NPI:1780855569
Name:NORTHEAST RADIOLOGY OF CT LLC
Entity type:Organization
Organization Name:NORTHEAST RADIOLOGY OF CT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:NADEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-278-6200
Mailing Address - Street 1:3839 DANBURY RD
Mailing Address - Street 2:NORTHEAST RADIOLOGY
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509
Mailing Address - Country:US
Mailing Address - Phone:845-278-6200
Mailing Address - Fax:845-278-7257
Practice Address - Street 1:31 OLD ROUTE 7
Practice Address - Street 2:NORTHEAST RADIOLOGY
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804
Practice Address - Country:US
Practice Address - Phone:845-278-6200
Practice Address - Fax:845-278-7257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC02142Medicare UPIN