Healthcare Provider Details

I. General information

NPI: 1518184746
Provider Name (Legal Business Name): PREFERRED MRI, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 02/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 N BROADWAY
HICKSVILLE NY
11801-2920
US

IV. Provider business mailing address

81 N BROADWAY
HICKSVILLE NY
11801-2920
US

V. Phone/Fax

Practice location:
  • Phone: 631-694-2816
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: LLOYD WAXMAN
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 631-694-2816