Healthcare Provider Details

I. General information

NPI: 1609914498
Provider Name (Legal Business Name): MOUNT VERNON HOSPITAL RADIOLOGY ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 10/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 N 7TH AVE
MOUNT VERNON NY
10550-2026
US

IV. Provider business mailing address

12 N 7TH AVE
MOUNT VERNON NY
10550-2026
US

V. Phone/Fax

Practice location:
  • Phone: 914-664-8000
  • Fax:
Mailing address:
  • Phone: 914-664-8000
  • 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: PAUL L NOVOTNY
Title or Position: DIRECTOR
Credential:
Phone: 914-664-8000