Healthcare Provider Details

I. General information

NPI: 1194956268
Provider Name (Legal Business Name): STAND-UP MRI OF MANHATTAN, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 AVENUE A
NEW YORK NY
10009-4094
US

IV. Provider business mailing address

110 MARCUS DRIVE
MELVILLE NY
11747-4228
US

V. Phone/Fax

Practice location:
  • Phone: 212-674-8300
  • Fax: 212-674-8828
Mailing address:
  • Phone: 631-390-1667
  • Fax: 631-390-1780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RONALD S WAGNER
Title or Position: OWNER
Credential: M.D.
Phone: 631-694-2816