Healthcare Provider Details

I. General information

NPI: 1821381633
Provider Name (Legal Business Name): SLR DIAGNOSTIC RADIOLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 05/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 AMSTERDAM AVE
NEW YORK NY
10025-1737
US

IV. Provider business mailing address

1090 AMSTERDAM AVE
NEW YORK NY
10025-1737
US

V. Phone/Fax

Practice location:
  • Phone: 212-590-2900
  • Fax: 212-523-4857
Mailing address:
  • Phone: 212-590-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number41391747
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number41391747
License Number StateNY

VIII. Authorized Official

Name: DR. JEANNE BAER
Title or Position: DIRECTOR
Credential: MD
Phone: 212-523-4272