Healthcare Provider Details

I. General information

NPI: 1962332114
Provider Name (Legal Business Name): FRONTIER RADIOLOGY OR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 INGOLD DR
DIX HILLS NY
11746-7804
US

IV. Provider business mailing address

8 THE GRN STE R
DOVER DE
19901-3618
US

V. Phone/Fax

Practice location:
  • Phone: 516-458-1853
  • Fax:
Mailing address:
  • Phone: 888-890-0690
  • Fax:

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: DR. JOSHUA EWELL
Title or Position: PRESIDENT
Credential: DO
Phone: 888-890-0690