Healthcare Provider Details

I. General information

NPI: 1992061006
Provider Name (Legal Business Name): WEST SIDE RADIOLOGY ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 03/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 5TH AVE
NEW YORK NY
10016-8728
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 646-935-2841
  • Fax: 646-935-2891
Mailing address:
  • Phone: 201-830-3200
  • Fax: 201-200-0838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MUNIR GHESANI
Title or Position: MEDICAL DIRECTOR
Credential: M.D
Phone: 212-523-7049