Healthcare Provider Details

I. General information

NPI: 1033125844
Provider Name (Legal Business Name): RADIOLOGIC ASSOCIATES PROF CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 E MAIN ST RADIOLOGIC ASSOCIATES
MIDDLETOWN NY
10940-2650
US

IV. Provider business mailing address

185 RYKOWSKI LN STE 101
MIDDLETOWN NY
10941-4055
US

V. Phone/Fax

Practice location:
  • Phone: 845-343-0616
  • Fax: 845-343-0617
Mailing address:
  • Phone: 845-692-0030
  • Fax: 845-692-0037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH LOUIS RACANELLI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 845-692-0030