Provider Demographics
NPI:1881743854
Name:MANHASSET DIAGNOSTIC IMAGING, P.C.
Entity type:Organization
Organization Name:MANHASSET DIAGNOSTIC IMAGING, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLNG
Authorized Official - Prefix:MISS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-222-2022
Mailing Address - Street 1:1350 NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3004
Mailing Address - Country:US
Mailing Address - Phone:516-222-2022
Mailing Address - Fax:516-222-8475
Practice Address - Street 1:1350 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3004
Practice Address - Country:US
Practice Address - Phone:516-222-2022
Practice Address - Fax:516-222-8475
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NRAD MEDICAL ASSOCIATES, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-09
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY290171792085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W14841Medicare ID - Type Unspecified