Provider Demographics
NPI:1801197603
Name:NEW IMAGE INTERVENTIONAL RADIOLOGY, PLLC
Entity type:Organization
Organization Name:NEW IMAGE INTERVENTIONAL RADIOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:AMATULLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-454-8700
Mailing Address - Street 1:1351 ROUTE 55
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:LAGRANGEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12540-5108
Mailing Address - Country:US
Mailing Address - Phone:845-454-8700
Mailing Address - Fax:845-790-5719
Practice Address - Street 1:169 MYERS CORNERS RD
Practice Address - Street 2:SUITE 250
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-3867
Practice Address - Country:US
Practice Address - Phone:845-454-4700
Practice Address - Fax:845-790-5719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-10
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty