Healthcare Provider Details

I. General information

NPI: 1962561126
Provider Name (Legal Business Name): MILLBASIN RADIOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 06/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 GREENWICH ST
NEW YORK NY
10013-3386
US

IV. Provider business mailing address

311 GREENWICH ST
NEW YORK NY
10013-3386
US

V. Phone/Fax

Practice location:
  • Phone: 212-732-1886
  • Fax:
Mailing address:
  • Phone: 212-732-1886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1404401
License Number StateNY

VIII. Authorized Official

Name: CLIFFORD BEINART
Title or Position: DIRECTOR OFFICER
Credential:
Phone: 212-732-1886