MEDICARE: STAT PORTABLE X-RAY,INC.

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	247100000X	Radiologic Technologist	H98 1204506 76	NY

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689791717
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STAT PORTABLE X-RAY,INC.

Provider Business Mailing Address
First Line	:	21118 UNION TPKE
Second Line	:
City	:	OAKLAND GARDENS
State	:	NY
Zip	:	11364-3241
Country	:	US
Telephone Number	:
Fax Number	:	718-217-5485

Provider Business Practice Location Address
First Line	:	21118 UNION TPKE
Second Line	:
City	:	OAKLAND GARDENS
State	:	NY
Zip	:	11364-3241
Country	:	US
Telephone Number	:	718-217-8000
Fax Number	:	718-217-5485

Authorized Official
Title or Position	:	NATIONAL MANAGER OF OPERATIONS
Name	:	MR. RICHARD PLATSCHEK
Credential	:
Telephone Number	:	718-217-8000

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	06/25/2008

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Directions to “STAT PORTABLE X-RAY,INC. ” Practice Location

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