Healthcare Provider Details

I. General information

NPI: 1134118607
Provider Name (Legal Business Name): NORTHEAST RADIOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 10/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3839 DANBURY RD
BREWSTER NY
10509
US

IV. Provider business mailing address

3839 DANBURY RD
BREWSTER NY
10509
US

V. Phone/Fax

Practice location:
  • Phone: 845-278-6200
  • Fax: 845-278-7802
Mailing address:
  • Phone: 845-278-6200
  • Fax: 845-278-7802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: HOWARD LEE
Title or Position: PRESIDENT
Credential: MD
Phone: 845-278-6200