Provider Demographics
NPI:1912251448
Name:EMPIRE RADIOLOGY PC
Entity Type:Organization
Organization Name:EMPIRE RADIOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOSECCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-324-2340
Mailing Address - Street 1:43 N HILLSIDE PL
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3027
Mailing Address - Country:US
Mailing Address - Phone:607-324-2340
Mailing Address - Fax:607-324-7615
Practice Address - Street 1:43 N HILLSIDE PL
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3027
Practice Address - Country:US
Practice Address - Phone:607-324-2340
Practice Address - Fax:607-324-7615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA079987002085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ617S01Medicare PIN