Healthcare Provider Details

I. General information

NPI: 1558336420
Provider Name (Legal Business Name): STAND-UP MRI OF EAST ELMHURST, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 06/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7533 31ST AVE
EAST ELMHURST NY
11370-1811
US

IV. Provider business mailing address

7533 31ST AVE
EAST ELMHURST NY
11370-1811
US

V. Phone/Fax

Practice location:
  • Phone: 718-779-2825
  • Fax: 718-779-5349
Mailing address:
  • Phone: 718-779-2825
  • Fax: 718-779-5349

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: LLOYD WAXMAN
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 631-694-2816