Healthcare Provider Details

I. General information

NPI: 1083964712
Provider Name (Legal Business Name): ENTERPRISE RADIOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2012
Last Update Date: 09/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4334 BROADWAY
NEW YORK NY
10033-2412
US

IV. Provider business mailing address

545 ELMONT RD
ELMONT NY
11003-4002
US

V. Phone/Fax

Practice location:
  • Phone: 516-495-7129
  • Fax: 516-977-2874
Mailing address:
  • Phone: 516-354-4200
  • Fax: 516-495-7129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number219543
License Number StateNY

VIII. Authorized Official

Name: DR. DANIEL E BEYDA
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 516-495-7115