Healthcare Provider Details

I. General information

NPI: 1598048316
Provider Name (Legal Business Name): SLR DIAGNOSTIC RADIOLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2011
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 4TH AVENUE
NEW YORK NY
10003
US

IV. Provider business mailing address

10 EXCHANGE PLACE 14TH FLOOR - WSBS
JERSEY CITY NJ
07302
US

V. Phone/Fax

Practice location:
  • Phone: 212-473-2300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JEANNE BAER
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 201-830-3122