Healthcare Provider Details

I. General information

NPI: 1124077938
Provider Name (Legal Business Name): ADVANCED M.R.I., PC-RAYTEL MEDICAL IMAGING-QUEENS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 08/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6860 AUSTIN ST
FOREST HILLS NY
11375-4220
US

IV. Provider business mailing address

7 WATERSIDE XING 3RD FLOOR ATTN: KAREN FRISK, CONTRACTING
WINDSOR CT
06095-1540
US

V. Phone/Fax

Practice location:
  • Phone: 718-575-0500
  • Fax: 718-275-1258
Mailing address:
  • Phone: 800-367-1095
  • Fax: 860-298-6127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberH98008160678
License Number StateNY

VIII. Authorized Official

Name: MR. JEFFREY M FLANEGIN
Title or Position: PRESIDENT
Credential:
Phone: 610-831-1112