Healthcare Provider Details

I. General information

NPI: 1841228582
Provider Name (Legal Business Name): NRAD MEDICAL ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 04/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 STEWART AVE SUITE 400
GARDEN CITY NY
11530-4822
US

IV. Provider business mailing address

990 STEWART AVE SUITE 400
GARDEN CITY NY
11530-4822
US

V. Phone/Fax

Practice location:
  • Phone: 516-222-2022
  • Fax: 516-222-8475
Mailing address:
  • Phone: 516-222-2022
  • Fax: 516-222-8475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. ANNETTE MARINACCIO
Title or Position: CHIEF EXECUTIVE
Credential:
Phone: 516-222-2022