Healthcare Provider Details

I. General information

NPI: 1659659076
Provider Name (Legal Business Name): EXPERT RADIOLOGY IMAGING, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2011
Last Update Date: 08/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 1ST AVE SUITE 30 L
NEW YORK NY
10016-3700
US

IV. Provider business mailing address

630 1ST AVE SUITE 30 L
NEW YORK NY
10016-3700
US

V. Phone/Fax

Practice location:
  • Phone: 917-903-2762
  • Fax:
Mailing address:
  • Phone: 917-903-2762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number201763
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number201763
License Number StateNY

VIII. Authorized Official

Name: DR. AMI ARVINDRAY SHAH
Title or Position: OWNER
Credential: M.D.
Phone: 917-903-2762