Provider Demographics
NPI:1932811122
Name:LONG ISLAND MOBILE MEDICAL IMAGING PC
Entity Type:Organization
Organization Name:LONG ISLAND MOBILE MEDICAL IMAGING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:I
Authorized Official - Last Name:LANDAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-312-2534
Mailing Address - Street 1:100 PATCO CT STE 5
Mailing Address - Street 2:
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-1522
Mailing Address - Country:US
Mailing Address - Phone:914-312-2543
Mailing Address - Fax:
Practice Address - Street 1:100 PATCO CT STE 5
Practice Address - Street 2:
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749-1522
Practice Address - Country:US
Practice Address - Phone:914-312-2543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology