Healthcare Provider Details

I. General information

NPI: 1568519833
Provider Name (Legal Business Name): WEST SIDE RADIOLOGY ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 11/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1790 BROADWAY LOWER LEVEL
NEW YORK NY
10019-1412
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 212-977-4100
  • Fax: 212-977-4271
Mailing address:
  • Phone: 201-830-3122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code2085R0205X
TaxonomyRadiological Physics Physician
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY TAMBURRINO
Title or Position: VP OF OPERATIONS
Credential:
Phone: 212-590-2900