Healthcare Provider Details

I. General information

NPI: 1003855404
Provider Name (Legal Business Name): PARK WEST RADIOLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W 57TH ST
NEW YORK NY
10019-3158
US

IV. Provider business mailing address

315 W 57TH ST
NEW YORK NY
10019-3158
US

V. Phone/Fax

Practice location:
  • Phone: 212-874-6362
  • Fax:
Mailing address:
  • Phone: 212-874-6362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DONOVAN SPAMER
Title or Position: MANAGER
Credential:
Phone: 212-772-3111