Healthcare Provider Details

I. General information

NPI: 1881743854
Provider Name (Legal Business Name): MANHASSET DIAGNOSTIC IMAGING, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 04/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 NORTHERN BLVD
MANHASSET NY
11030-3004
US

IV. Provider business mailing address

1350 NORTHERN BLVD
MANHASSET NY
11030-3004
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 TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number29017179
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MISS LESLIE BAY
Title or Position: DIRECTOR OF BILLNG
Credential:
Phone: 516-222-2022