Healthcare Provider Details

I. General information

NPI: 1578601662
Provider Name (Legal Business Name): MRI ASSOCIATES OF QUEENS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 11/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9237 METROPOLITAN AVE
FOREST HILLS NY
11375-6623
US

IV. Provider business mailing address

9237 METROPOLITAN AVE
FOREST HILLS NY
11375-6623
US

V. Phone/Fax

Practice location:
  • Phone: 718-544-7994
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number147975-1
License Number StateNY

VIII. Authorized Official

Name: VIKI BUBANY
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 718-544-7994