Healthcare Provider Details

I. General information

NPI: 1124655352
Provider Name (Legal Business Name): IMAGING SUBSPECIALIST OF NEW YORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 03/26/2020
Certification Date: 03/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 CRYSTAL RUN RD
MIDDLETOWN NY
10941-4040
US

IV. Provider business mailing address

285 RIVER RD
NYACK NY
10960-5001
US

V. Phone/Fax

Practice location:
  • Phone: 845-673-6446
  • Fax:
Mailing address:
  • Phone: 646-407-2044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. VINCENT GRAZIANO
Title or Position: PRESIDENT
Credential: MD
Phone: 646-407-2044