Healthcare Provider Details

I. General information

NPI: 1225069149
Provider Name (Legal Business Name): SLR DIAGNOSTIC RADIOLOGY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 02/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 AMSTERDAM AVE DEPT OF RADIOLOGY
NEW YORK NY
10025-1716
US

IV. Provider business mailing address

PO BOX 10269
UNIONDALE NY
11555-0269
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2085R0205X
TaxonomyRadiological Physics Physician
License Number
License Number State

VIII. Authorized Official

Name: JEANNE BAER
Title or Position: PRESIDENT
Credential: MD
Phone: 201-830-3122