Healthcare Provider Details

I. General information

NPI: 1659711653
Provider Name (Legal Business Name): STEPHEN PILCH R.R.A., R.T. (R)
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2013
Last Update Date: 07/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 FIRST AVENUE
NEW YORK NY
10016
US

IV. Provider business mailing address

1203 CRESTWYCK CIR
MOUNT JOY PA
17552-7211
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-7300
  • Fax:
Mailing address:
  • Phone: 609-923-4659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number438694
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: