Healthcare Provider Details

I. General information

NPI: 1376545012
Provider Name (Legal Business Name): CENTRAL RADIOLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 02/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13710 NORTHERN BLVD
FLUSHING NY
11354-4122
US

IV. Provider business mailing address

13710 NORTHERN BLVD
FLUSHING NY
11354-4122
US

V. Phone/Fax

Practice location:
  • Phone: 718-888-9180
  • Fax: 718-888-9260
Mailing address:
  • Phone: 718-888-9180
  • Fax: 718-888-9260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MARY X. HU
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-888-9180