Healthcare Provider Details

I. General information

NPI: 1699948208
Provider Name (Legal Business Name): DIAGNOSTIC RADIOGRAPHIC IMAGING P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2008
Last Update Date: 04/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 COMMUNITY DRIVE
GREAT NECK NY
11021
US

IV. Provider business mailing address

290 COMMUNITY DRIVE
GREAT NECK NY
11021
US

V. Phone/Fax

Practice location:
  • Phone: 516-487-1902
  • Fax: 516-487-4156
Mailing address:
  • Phone: 516-487-1902
  • Fax: 516-487-4156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KEVIN E HARRISON
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 516-487-1902