Healthcare Provider Details

I. General information

NPI: 1508033341
Provider Name (Legal Business Name): SLR DIAGNOSTIC RADIOLOGY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 05/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 UNION SQ E DEPT OF RADIOLOGY, SUITE 3P
NEW YORK NY
10003-3314
US

IV. Provider business mailing address

10 EXCHANGE PL 14TH FLOOR WSBS
JERSEY CITY NJ
07302-3918
US

V. Phone/Fax

Practice location:
  • Phone: 212-844-8880
  • Fax:
Mailing address:
  • Phone: 201-830-3122
  • Fax: 201-200-0838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code2085R0205X
TaxonomyRadiological Physics Physician
License Number
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number StateNY
# 8
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateNY

VIII. Authorized Official

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