MAIN STREET RADIOLOGY AT BAYSIDE LLC NPI 1598852469

NPI Information

NPI: 1598852469
Provider Name: MAIN STREET RADIOLOGY AT BAYSIDE LLC
Classification: Radiology - 2085R0202X
Entity Type: Organization

Specialization: Diagnostic Radiology

CLIA Number: 33D2256204

Address:
4401 FRANCIS LEWIS BLVD
BAYSIDE, NY
ZIP 11361
Phone: (718) 428-1500
Get Directions

MAIN STREET RADIOLOGY AT BAYSIDE LLC is a diagnostic radiology radiology in Bayside, NY. The provider is a radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. MAIN STREET RADIOLOGY AT BAYSIDE LLC NPI is 1598852469. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

4401 FRANCIS LEWIS BLVD
BAYSIDE, NY
ZIP 11361-002
Phone: (718) 428-1500
Fax: (718) 352-0292

The provider's authorized official is Ari Jonisch .
The authorized official title is Officer and has the following contact phone number (718) 428-1500.

The CLIA number assigned to this NPI record is 33D2256204 - other - radiology with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/10/2006 and was last updated on 11/3/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2085R0202X	Radiology	Diagnostic Radiology			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	02217256	MEDICAID	NEW YORK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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