MEDICARE: LONG ISLAND MEDICAL IMAGING, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0200X	Radiology Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073788188
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONG ISLAND MEDICAL IMAGING, PC

Provider Business Mailing Address
First Line	:	1161 MONTAUK HWY
Second Line	:
City	:	WEST ISLIP
State	:	NY
Zip	:	11795-4930
Country	:	US
Telephone Number	:	631-277-1600
Fax Number	:	631-277-1638

Provider Business Practice Location Address
First Line	:	1161 MONTAUK HWY
Second Line	:
City	:	WEST ISLIP
State	:	NY
Zip	:	11795-4930
Country	:	US
Telephone Number	:	631-277-1600
Fax Number	:	631-277-1638

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. ALBERT ZILKHA
Credential	:	M.D.
Telephone Number	:	631-277-1600

Provider Enumeration Date	:	04/29/2008
Last Update Date	:	10/13/2009

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