Healthcare Provider Details

I. General information

NPI: 1619943495
Provider Name (Legal Business Name): ISLAND DIAGNOSTIC IMAGING ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 01/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 MERRICK RD
MASSAPEQUA NY
11758
US

IV. Provider business mailing address

4160 MERRICK RD
MASSAPEQUA NY
11758
US

V. Phone/Fax

Practice location:
  • Phone: 516-797-6700
  • Fax: 516-797-8463
Mailing address:
  • Phone: 516-797-6700
  • Fax: 516-797-8463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number29022743
License Number StateNY

VIII. Authorized Official

Name: DR. STEVEN MARK PEYSER
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 516-797-6700