Provider Demographics
NPI:1821180159
Name:STAND-UP MRI OF DEER PARK, P.C.
Entity type:Organization
Organization Name:STAND-UP MRI OF DEER PARK, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HERSHOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-396-1050
Mailing Address - Street 1:PO BOX 170
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-0170
Mailing Address - Country:US
Mailing Address - Phone:631-396-1050
Mailing Address - Fax:631-396-1056
Practice Address - Street 1:1118 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-3102
Practice Address - Country:US
Practice Address - Phone:631-243-3222
Practice Address - Fax:631-243-3355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02864868Medicaid
NYWTB821Medicare PIN